They are often referred to as ports, Broviacs or Hickmans. If you’ve already had a central line put in, you know what type it is and how to care for it. You’ll find more information about dealing with your central line in Body Issues. If you haven’t yet had your line implanted, here’s some useful information.
Why do I need a Central Line or Port?
As your treatment continues, you will often need medications, blood products, and possibly nutrients given intravenously. You will also have endless blood tests. Having a central line eliminates the need for repeated needle sticks to start an IV line or draw blood. Even though surgery is required, it will be worth it.
How Do They Work?
All central lines work on the same general principle. A small tube or catheter is surgically implanted and then fed into the superior vena cava – a major vein in the right ventricle of your heart. Your medications and other supplements can be infused directly into your system. A central line not only avoids needle sticks, it also prevents possible tissue damage caused by leakage of corrosive chemotherapy drugs (it’s rare, but it can happen). Your central line can also be used to draw blood for testing, again eliminating the need for painful needle pokes.
What Are They Like?
There are two main types of central lines: external and subcutaneous (under the skin). You may have a PICC line inserted temporarily. You and your medical team will discuss which type is best for you.
The two most common types of external central lines are the Broviac and Hickman (refers to the company that makes them). Central lines are almost always surgically implanted while you are under general anesthesia. First, a small incision is made in the area under your collarbone. One end of the catheter is fed into a large vein (the superior vena cava) leading directly into your heart. The other end of the catheter is “tunneled” under your skin for a short distance, where it exits through another small incision at a spot near your breastbone. The catheter branches out into one or more smaller tubes called lumens that hang on the outside of your body. A sterile dressing covers the exit site at all times. All chemotherapy drugs, transfusions, and fluids are infused through these lumens or “ports”. Depending on your treatment plan, you may have several different types of fluids or meds being infused at the same time through different ports. Sometimes, if the drugs are compatible, you might have two different drugs going through the same lumen at the same time.
Subcutaneous (under the skin) or Implantable Lines
This type of central line is usually referred to as a medi-port or port-a-cath. Unlike a Broviac or Hickman, an implantable port is completely under the skin. This type of catheter is surgically implanted, usually in your chest but some teens have them in their arms. Most teens have general anesthesia for this procedure. One end of the catheter is fed into a large vein leading directly into your heart. The other end is attached to a small chamber called a portal. The portal is made of either metal or plastic with a rubber top that seals it and is placed under your skin. You will feel a small bump under your skin where the portal has been placed. When you need to use your port, it is accessed with a special needle (a Huber needle) that has a tube attached to it, much like the lumen on a Broviac. Your meds or whatever will flow through the needle, into the catheter and then into your bloodstream. After a while, the skin over your port becomes very tough and insensitive. You can also use EMLA cream to numb the area.
How Do I Take Care of My Line?
External lines are more difficult to take care of than under-the-skin ports. Special care must be taken while bathing to avoid getting the exit site wet and it may be recommended that you don’t go swimming. A Broviac or Hickman must always have a sterile dressing covering it. Check with your medical team to learn their requirements about changing the dressing. Most hospitals will have a special teaching sheet to show you how to change your dressing. You can always have a nurse or your parent do it for you, but many teens prefer to do it themselves. It’s usually more convenient and much more private. FlushedYour lines need be flushed daily to prevent clotting and the caps on the ends of the line need to be changed regularly. Your individual situation will determine how often. Check with your medical team about how to specifically care for your central line. Subcutaneous catheters (or medi-ports, port-a-caths) are easier to maintain than external lines. They too need to be flushed with a heparin solution to prevent clotting but usually only once a month or after each use. There is no worry about swimming, bathing or showering with this system. Normal activities can be continued. You will more fully discuss how to care for your line with your medical team.
PICC Line (peripherally inserted central catheter)
You may have a PICC line – peripherally inserted central catheter – inserted for some of your treatment. Often a PICC line is used when treatment is short term or until a more durable central line can be surgically implanted. These are simpler and less invasive than other central catheters and can be inserted by a nurse. The PICC is a thin flexible catheter, about 60cm long, which is inserted in your upper arm. It then feeds into the superior vena cava – the big vein just above the heart. PICC lines are easier to maintain than some others. You medical team will give you specific instructions how to care for your PICC line.