Imagine how frightening it could be to a child in the hospital, who must undergo daily, repeated needle sticks for testing and treatment of a serious disease. Parents must go through the agony of watching their child cry as they try to explain that the painful needles are going to help them get better. Central Venous Catheters, or CVCs, are a highly desirable alternative to multiple daily, weekly and monthly needle sticks.
Function
A Central Venous Catheter, or CVC, allows access to large, central veins in children undergoing chemotherapy, bone marrow transplants, stem cell replacements, or treatment for blood abnormalities. Parenteral nutrition --- for those who cannot eat; delivering blood components; frequent need for intravenous, or IV fluids; delivering powerful medications; and frequent blood sampling are also common reasons to use a CVC. According to Signa Vitae, a journal for intensive care and emergency medicine, "CVCs are amongst the most frequently performed invasive procedures for the severely ill or long-stay hospital, pediatric patients."
Types
In the Oxford Journal, "Annals of Oncology," partially implanted CVCs are used most in children; they are partially above and below the skin surface. The Groshong, a pressure activated safety valve, or PASV and the classic Hickman-Broviac are recommended most often for use in babies, children and teens. They may have a single lumen --- short tube with safety opening --- or double lumens above the skin, where liquids are inserted or removed. These lumens are attached to a tiny, flexible catheter with the other end placed near or at the heart. Use of peripherally inserted central venous catheters, or PICC lines, usually put into an arm, are on the increase in children. PICC lines and other CVCs are used in a hospital and sometimes left in place after discharge for home use.
Benefits
The benefits of having a CVC in place, besides offering a non-painful way to give children treatments and to take frequent blood samples, include a more accurate and efficient delivery of medications and nutrition due to the fact that these are most often placed directly above the heart, usually the right atrium. This allows the heart to pump the medicine throughout the body as well as avoiding phlebitis, which is inflammation of smaller blood vessels. Some medications can be irritating to the lining of veins and the CVC offers alternate, reliable access in the management of frequent, often life-saving treatments.
Complications
In a 2005 study performed in two pediatric hospitals in Italy, researchers studied four complications of CVCs and found that infection was most common, followed by mechanical accidents, or poor placement, malfunction of the catheter itself and thrombosis, or formation of blood clots. Their conclusion was that out of 418 patients, some form of complication occurred up to 40 percent of the time. They further explained these results depended on the underlying disease, length of time used, the age of the child and the type of medication or nutrition given. Kids with hematological, or blood malignancies such as leukemia and lymphoma experienced more complications than children with solid tumors.
Features
The most common sites used for CVC insertion include the jugular vein in the neck, the subclavian vein just under the collarbone, or the umbilical vein in newborns. These procedures are done under strict sterile technique and safety precautions are taken after insertion, including X-rays to insure proper placement of the tip, EKG, heart rate and oxygen saturation testing, and frequent checks for flow by flushing saline or heparin, to keep the vein "open." A study in Signa Vitae showed risk of complications being in the range of .7 percent to 26 percent, with the duration of the catheter use directly related to that risk. Sterile dressing changes are typically performed once a week and parents are instructed on how to meticulously perform these if their child needs further treatment after discharge.
