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What is an implanted central venous tunneled catheter and a central venous port?
An implanted central venous tunneled catheter/port allow a soft special (silicone) IV catheter to be placed in your child without the need for repeated peripheral IV stick.
With an implanted central venous tunneled catheter, the catheter is tunneled under the skin and brought out on the chest or abdomen away from the site where it enters the vein. Theoretically, this prevents bacteria from gaining access to the central portion of the catheter. Finally, catheters contain a "cuff" which is buried under the skin. Your child's tissues will grow into this "cuff" and allow the catheter to become more stable, which will reduce the chance of it becoming pulled out.
A port is slightly different in where the tunneled catheter exits the skin, the port is actually buried under the skin. The purpose of a port is the same as a tunneled catheter. Your physician and surgeon will decide which is required on a per-patient-need basis.
What is the purpose of a central venous catheter or port?
It may be used for chemotherapy, IV medications, IV nutrition, transfusion of blood products and obtaining blood samples. If the tunneled catheter is injected (flushed) regularly with an anti-clotting medicine, it does not need to be attached to an IV bag all the time. This allows your child to be mobile.
How are implanted central venous tunneled cathers or ports placed?
Central venous catheters are generally placed in an operating room setting. Your child will undergo a general anesthetic (completely asleep) when the catheter is inserted. Additionally, the surgeon will need to use X-rays (fluoroscopy) while placing the line - something which can't be done at the bedside.
What happens during surgery?
The doctor makes a small opening in the mid-chest area. Another opening is made where the catheter will enter the vein. A tunnel is formed under the skin between the two openings.
The catheter is passed through this tunnel and then gently threaded into the vein. With a port, the surgeon makes a pocket under the skin, in which the Mediport is secured and completely out of site.
Your child will get a chest X-ray after surgery, with either surgery, to document the catheter is in the proper location. Small bandage tapes, called Steri-strips are placed over the openings. The catheter may also have a few stitches, which dissolve on their own, to hold it in place.
What are possible complaications or contraindications?
Like all surgical procedures, placement of a central venous catheter carries its own risks of bleeding, infection and damage to the surrounding structures. A reported problem is the risk of pneumothorax (air in the chest, outside of the lung) that can come from a punctured lung. Although not common, a pneumothorax is usually treated with observation. Occasionally there is a need for administration of oxygen or placement of chest tube.
In the case of infection, we ask that you and the nurses treating your child monitor the area around the insertion site. When the nurse changes the dressing, he or she will check for signs of infection, including redness, swelling, and/or drainage. Fever is another sign of infection, for which you should seek medical attention.
How are tunneled catheters and removed?
In general, a Broviac catheter needs to be removed with a conscious sedation or light general anesthesia. This will require a visit to hospital as an outpatient. The procedure itself lasts only a few moments. A light dressing will be placed over the site where the Broviac catheter was. This should stay clean and dry for 2 days and then may get wet in a bath or shower. The dressing should be removed at this time and you may apply polysporin/Neosporin ointment to the wound site until completely healed. Because it is a see-through dressing, don't be surprised if you see a few drops of blood on the dressing. Tylenol or Children's Motrin (according to their age and weight) may be used for pain.
With a port removal, your child will need to be taken to the operating room to have it removed, similarly to the port placement, the child can go home on the same day. (See above for post op care.)
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