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What is a Central Venous Catheter (CVC)?
A CVC is used to help give a child their treatment. Treatment might include chemotherapy, other drugs and fluids or blood products. The CVC may also be used for taking most blood samples that need to be taken. A CVC is a small silicone rubber tube which is inserted in theatre under a general anaesthetic. Two incisions will be made to enable the line to be put in place; one in the neck and the second in the chest. A tunnel is made under the skin through which the CVC is threaded. One end of the CVC will be placed into a large central vein and the other end of the catheter will be used for the nurses and doctors to administer treatment. The CVC has a cuff which is placed under the skin; this cuff helps the CVC to remain in place. Common types of CVCs are also known as Hickman lines and Port-a-caths.
How to Care for a Hickman Line
It is important to check the chest site of the Hickman line daily. This is to ensure that the dressing remains secure and in place, and also that there is no infection. Signs of infection could include
your child having a temperature over 38o C, redness, swelling or pain around the site, or if the site has any discharge (either pus or blood). If your child shows any sign of infection you must seek advice immediately as instructed by the Children’s Community Nursing Team.
When carrying out the daily check, ensure that the line is securely looped under the dressing and that the dressing is firmly attached to the chest. Should the dressing not be secure, place a further dressing on top of the existing one. Please check that the bungs are affixed tightly at the end of the line as this will reduce the risk of them falling off. It is very important that you ensure that the clamps remain closed. This will reduce the risk of blood loss should the bungs fall off or if the line becomes broken.
Should the clamps be found to be open please contact the Children’s Community Nursing Team as the line will need flushing and stabilising to keep it safely working and prevent the line blocking.
It is important to keep the dressing, site and Hickman line dry. At bath times the line can be taped to keep it out of the way, or you can even place the ends in a clean plastic bag (such as a sandwich bag), and then tape the bag. The ends of the Hickman line should be kept away from the nappy/groin area to avoid contamination. Should the ends become soiled with faeces, the bungs will
need to be replaced and the line thoroughly cleaned.
If the bung at the end of the line falls off but the clamps are still securely in place, this must be replaced with a new bung. Before attaching the replacement, wash hands thoroughly using an
antibacterial pump wash and clean the end of the central line using a Sani-cloth© and allowing the area to dry before attaching the replacement. Use three areas of the wipe on the end of the line and use pressure when cleaning. The end of the line should not be touched with hands during the process. If the clamps are open and the bungs are off, this is an emergency situation. You MUST close the clamp, replace the bung and contact the Children’s Community Nursing Team or Ward 5 for further advice.
If the line is removed accidentally, pressure should be applied at the two incision sites (one in the chest and one on the neck) for ten minutes to stop any bleeding. Contact the Children’s Community Nursing Team or Ward 5 for advice or call 999 if your child needs immediate assistance. The Hickman line will need to be replaced in theatre.
Damage to the Line
Should the line become damaged or if there is a hole in the line, the line should be clamped between the chest and the break. If the clamps are not available, bend the line and hold with fingers.
The line can be mended, so to minimise any further damage to the line, an occlusive dressing (such as IV3000) should be wrapped around the hole and a piece of sterile gauze placed under the blue clamps. Always use two clamps in the event of any damage. Contact the Children’s Community Nursing Team or Ward 5 for advice or call 999 if your child needs immediate assistance.
Dressing Changes and Care of the Line
The dressing will be changed at least once a week by the Children’s Community Nursing Team. The team will also flush the line at least once a week. This will ensure that the line remains open by
preventing blockages and can be used in the future, even if no medication is required at the present time.
The safety kit should be kept with your child at all times. Contained within this kit is:
• 2x pack of sterile gauze
• 3x IV3000
• 2x blue clamps
• 2x bungs (needleless access device)
• 4x Sani-cloth wipes©
• 1x roll of medical tape
You will be shown how to use the kit before you are discharged from hospital. If you have any questions please ask your nurses.
Important Points to Remember
• If you have any questions regarding the care of a Hickman line, please call the Children’s Community Nursing Team for advice and support.
• If you have any urgent concerns, or if the line has come out or been broken, please seek immediate medical assistance. If you are unable to speak to a member of the Children’s Community Nursing Team straight away, please call 999.
• When drying hands (once they have been washed) use disposable towels such as kitchen roll to reduce the risk of cross-infection.
• When possible, try to keep the Hickman line under clothing. This will reduce the risk of the line being pulled out. Try to keep younger children from playing with the line.
• If there is a hole in the catheter, keep the line below your child’s heart. This is to reduce the chance of an embolism occurring.
• If your child is attending school with a Hickman line, please inform school staff and also advise them what action is required in the event that the line becomes broken or removed.
• If you get given bags to put the lines in (wiggly bags) don’t forget that they need to be washed and each wiggly bag should only be worn for one day at a time.
Children’s Community Nursing Team telephone number: 01908 996518
Working hours: Monday – Friday: 08:30 – 16:30 Saturday: 09:00 – 12:00
Paediatric Assessment Unit (Ward 4) telephone number: 01908 996367
Ward 5 telephone number: 01908 996377