Central Venous Catheter (CVC)
A central venous catheter is a flexible tube inserted into the right atrium of the heart to deliver chemotherapy.
During therapy, medications, fluids, antibiotics, blood products and nutrition are given by intravenous infusion. Children also have many blood tests. Central lines deliver drugs directly into the bloodstream, and blood samples can be taken. This eliminates need for many IVs.
The catheter can be left in place for several years.
A Central Venous Catheter may also be called a Central Line or Venous Access Device (VAD).
Subcutaneous ports and external lines are used for children with retinoblastoma:
Subcutaneous Port (Port-a-Cath, Infusaport or Medi Port)
The line is implanted under the skin and “accessed” with a special needle after the skin has been numbed. The port has a self‑sealing top designed to withstand years of needle sticks.
When the port is accessed, the needle is attached to a short length of tubing, sealed with a bung when not in use. A transparent dressing is placed over the site. Ports can remain accessed for up to seven days before they must be reaccessed with a new needle to prevent infection.
External Line (Hickman or Broviac)
A small length of tubing extends outside the skin, sealed at the end with a bung when not in use. The child feels no pain because the end of the tube is outside the body. External lines require meticulous care to minimise infection risk.
External / Subcutaneous Catheter Comparison
The following table summarizes pros and cons of both catheters.
|External Line||Subcutaneous Port|
|Pain||Dressing Changes||Needle pokes to access|
|Cost||More due to daily care||Lower due to monthly care|
All central venous catheters require special care to minimize risk of infection and other complications that can be especially problematic tor a child receiving chemotherapy. Learn more about catheter care and risks.
Catheters are placed under general anaesthetic usually in less than an hour.
One end of the catheter is threaded through a large vein in the neck into the right atrium of the heart. The other end is tunnelled under the skin of the chest to the portal (subcutaneous port) or exit point (external line). Fluid is injected to ensure the line works properly. The remainder of the surgery depends on the type of line.
Subcutaneous catheters are attached to the portal which is placed under the skin in the right chest, and stitched to underlying muscle. Two tiny scars and a bump under the skin (the port) are the only visible signs of the catheter.
External catheters are stitched to the skin where tubes exit the chest. Tissues bond with a Dacron cuff surrounding the catheter, just under the skin. This helps to anchor the catheter and prevent infection-causing bacteria from entering the bloodstream.
Some hospitals do not use implanted catheters, either because they are not available or because doctors feel the risk of infection is too high. Ask your child’s doctor what the options are, and request an alternative if you feel it would be better for your child.