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Central Venous Line (CVL)

What is a CVL?

Central Venous Line
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A central venous line is a tube that is inserted into the major blood vessels leading to your child’s heart.
CVL is short for Central Venous Line. You might also hear a CVL called a central line or a central venous catheter. A CVL is a long, soft, thin, flexible tube that is inserted into one of the large veins leading to the heart.

A CVL is a special intravenous (IV) line that is used in children who need IV therapy for a long time. IV therapy means medicine that is put into the vein. Children's veins may become damaged by frequent, painful needle insertions. A CVL makes it easier and more comfortable for your child to receive medicines such as chemotherapy and IV fluids, or to have blood samples taken. Some treatments like dialysis also need a CVL.

This page explains how a CVL is put in, how to get ready for the procedure, and how to take care of your child. Use this information to explain to your child what to expect, using language she can understand.

Before the procedure

If your child is already in the hospital, you will meet a nurse from the Vascular Access Service who will explain the procedure and answer your questions. If your child is an outpatient, the medical team looking after your child will explain the procedure to you.

The doctor inserting the CVL will meet with you to explain the procedure, answer your questions, and get your consent.

You will also meet with the anesthetist before the procedure. This is the doctor who will give your child the sleep medicine (anesthetic).

Talk about the procedure with your child

It is important to talk to children about what will happen before any procedure. Children feel less anxious when they know what to expect. Talk to your child in a way that she will understand. It is important to be honest. Tell your child that she will not wake up during the procedure, but will wake up afterward. If you are not sure how to answer your child's questions, ask the Child Life Specialist on your unit for help.

Blood tests

Your child may need blood tests before coming for the procedure. This is for your child's safety. Your child's doctor will arrange this.

Food and fluids

On the day of the procedure, your child will receive a general anesthetic. This means that she may not have any solid food on the day of the procedure before the surgery. Your child can have fluids as follows:

What your child can eat and drink before the sleep medicine (sedation or general anaesthetic)

Time before procedure

What you need to know

Midnight before the procedure

No more solid food. This also means no gum or candy.

Your child can still drink liquids such as milk, orange juice, and clear liquids. Clear liquids are anything you can see through, such as apple juice, ginger ale, or water.

Your child can also eat Jell-O or popsicles.

6 hours

No more milk, formula, or liquids you cannot see through, such as milk, orange juice, and cola.

4 hours

Stop breastfeeding your baby.

2 hours

No more clear liquids. This means no more apple juice, water, ginger ale, Jell-O, or popsicles.

If you were given more instructions about eating and drinking, write them down here:

 

It is very important that your child's stomach is empty during and after the anesthetic. An empty stomach reduces the chance of throwing up and choking.

What happens during the procedure

Your child will have a special "sleep medicine" called a general anesthetic before the procedure. This will make sure that your child sleeps through the procedure and will not feel any pain.

An interventional radiologist or surgeon will insert your child's CVL in the Image Guided Therapy (IGT) department or in the Operating Room (OR). IGT uses special equipment to perform procedures that may have needed traditional surgery in the past.

During the procedure, the doctor threads the CVL tube through a vein in the neck and places it in the large vein leading to the heart, where the blood flow is fast. This placement allows for better mixing of medicines and IV fluids.

Equipment such as ultrasound and fluoroscopy, a special X-ray machine, may be used during the procedure. A chest X-ray may be taken after the procedure to ensure the CVL is in the correct position.

It will take about 1 hour to insert the CVL.

During the procedure, you will be asked to wait in the waiting area. When the procedure is over and your child starts to wake up, you may see your child. Once the CVL is inserted, the doctor or nurse will come out and talk with you about the procedure.

Risks of inserting a CVL

Any procedure carries some risk. Every procedure is judged by weighing the benefit for your child against the risk it may pose. Procedures vary from low risk to high risk.

A CVL insertion is usually considered low risk. The risks of the procedure will vary depending on the condition of your child, the age and size of your child, and any other problems she may have.

The risks of any central catheter insertion, including a CVL, can include:

  • failure to find an open vein that will accept the CVL
  • bleeding or bruising
  • infection
  • clotting
  • air in the lungs or veins
  • breaking a blood vessel
  • abnormal heart rhythm
  • breaking the catheter
  • death (very, very rare)

What to expect after the procedure

After the procedure, your child will have 2 large bandages, 1 on her neck and 1 over her chest area. These bandages are sterile. This means that they are put on in a special way to keep the site as germ-free as possible.

The neck dressing is cloth-like and will be removed within a few hours. There will also be a bandage over the CVL exit site on the chest wall. It is normal to see some blood under this bandage. You will see a small stitch in both the neck and chest area. These stitches will dissolve and fall off on their own, usually within a few weeks.

The CVL can be used right away.

Your child may feel some pain or discomfort after the procedure

For the first day or two after the procedure, some children may feel mild pain or discomfort in the neck or chest. If this happens, ask your nurse or doctor if you can give your child something for pain.

Often, children feel like they have a stiff neck due to the neck bandage. It is good and safe for your child to move her neck as usual.

Your child will not feel any pain when the CVL is being used.

How to care for the CVL

There must always be a bandage over the CVL site on the chest. This bandage keeps the CVL clean and secure. The end of the catheter tube, called the hub, will be closed with a cap.

While you are in the hospital, the nurses will care for your child's CVL. The nurses will change the bandages and care for the CVL using sterile equipment. This prevents the CVL from becoming infected.

When you go home, a Community Care Nurse will care for your child's CVL. As you become more comfortable caring for the CVL, the Community Care Nurses will teach you how to provide some of this care yourself.

The CVL will always have either an infusion or a heparin lock. An infusion means that fluids are passed through tubing and a pump. Heparin is a medication that helps prevent the CVL from becoming blocked so that it will work well every time your child needs IV medications or fluids. New heparin will be flushed into the CVL after each use. If it is not being used each day, the heparin flush will be done every 24 hours.

It is always important to keep the CVL dry. If the CVL gets wet, it can become infected. Your nurse will teach you how to cover the CVL to keep it dry when your child bathes. If the bandage gets wet, it should be changed right away.

Protect the CVL

Although the CVL is quite secure, it can come out if it is pulled. It is very important to make sure the CVL is always taped in a looped position and covered with a bandage. It is also important that the end of the catheter, called the hub, is taped to your child's chest or tummy to prevent it from being pulled out by accident.

Often gauze is wrapped around the end of the catheter to help keep it clean and to prevent rubbing against your child's skin. Keeping the CVL taped to the body will also prevent it from twisting or kinking. This is very important to prevent it from becoming damaged or broken.

What to look out for after the CVL insertion

Contact your Community Care Nurse, the Vascular Access Service at the hospital, or your doctor or clinic nurse if you see any of the following:

  • Your child has fever or chills.
  • Your child has bleeding, redness, or swelling around the CVL or neck.
  • Your child has leaking or drainage at the CVL site.
  • Your child's CVL is hard to flush or will not flush at all.
  • Your child has pain when the CVL is being used.
  • Your child's CVL is dislodged or comes out a little or all the way.

Because each child's situation is different, you should also ask your doctor if there are any specific instructions for your child.

Activities

After the CVL is inserted, your child will be able to go back to most activities within a day or two as long as she is not experiencing any pain. This includes going to day care or school. Tell your child's caregivers or teachers about the CVL.

Your child may also be able to play some sports and games such as bike riding and tennis. It is important for your child to maintain as many usual activities as possible. There are a few things that should be avoided:

  • Avoid water sports or swimming. A wet bandage increases the risk of infection. If the bandage becomes wet, it should be changed right away.
  • Avoid using scissors anywhere near the CVL. No one (your child, a nurse or doctor, or yourself) should be allowed to use scissors near the CVL. This will prevent it from being cut.
  • Avoid sports that might result in a hit to the CVL or cause the catheter to be pulled out, such as hockey, football, gymnastics, or basketball.
  • Do not let other children touch or play with the CVL.

What to do if the CVL breaks

Before you leave the hospital, you will be given a CVL Emergency Kit. The kit contains the supplies you will need if your child's CVL breaks. A nurse will give you the kit and review it with you before you leave. You should always make sure that the kit is with your child in case the CVL is ever broken.

If the CVL breaks, do the following:

  1. Remain calm. Clamp the CVL between the break and your child.
  2. Clean the broken area with a chlorhexidine swab.
  3. Place clean gauze under the broken area and tape the CVL to the gauze. Wrap the gauze around the catheter, then tape this gauze roll to your child's chest.
  4. If the hole is small, you should try to heparinize the CVL (if you have been taught) to help prevent it from becoming blocked. Heparinize means to inject or flush heparin into the CVL cap. 
  5. Call the Vascular Access Service as soon as you have done this for further instructions. You will be asked to come to the hospital for assessment.

Some CVLs can be repaired without having to be replaced. Some broken CVLs will need to be removed.

What to do if the cap falls off

If the cap falls off, obtain supplies from the CVL Emergency Kit and follow these steps:

  1. Wash your hands.
  2. Wipe the end of the CVL with a chlorhexidine swab.
  3. Take a new cap from the kit and screw it onto the hub. Wrap and tape gauze around the catheter.
  4. Tape the gauze roll to your child's chest.
  5. The cap must be changed as soon as possible using the sterile technique, either by you if you have been trained, or by your Community Care Nurse.

Things you should know about your child's CVL

It is important that you know a few facts about your child's CVL. If you have a problem and need to call the Community Care Nurse or Vascular Access Service, it will be helpful to give them the following information about your child's CVL as well as information about the problem. Complete the following information.

Date of insertion:

Catheter type and size (circle one that applies):

  • single lumen
  • double lumen
  • triple lumen

Catheter utilization (circle all that apply):

  • antibiotics
  • blood products
  • chemotherapy
  • medicines
  • blood sampling
  • TPN
  • other:

Notes about the CVL:

 

 

 

How long the CVL can stay in

A CVL can stay in for months or years as long as it remains problem free and working well.

Once your medical team is confident that the CVL is no longer needed, they will make arrangements for the CVL to be removed. CVLs are removed under sedation or general anesthetic (sleep medicine). This procedure takes about 30 minutes. Eating and drinking restrictions and blood work on the day of the procedure are similar to when the CVL was inserted.

Contact information

If you have any questions or concerns about your child's CVL, call one of these numbers:

Community Care Nurse:

Vascular Access Service:

Your child's doctor or nurse:

Other:

Key points

  • A central venous line (CVL) is a long, thin, flexible tube used in children who need IV therapy for a long time.
  • The CVL is inserted into a vein in the neck and placed in the large vein leading to the heart.
  • Your child will receive a general anesthetic to sleep and will not hear anything of feel any pain during the procedure.
  • A CVL insertion is usually considered a low-risk procedure.

Bairbre Connolly, MB, BCH, BAO; DCH; FRCSI, MCh; FFRRCSI; lmCC, FRCP(C), MD

Barbara Bruinse, RN, BSc, BScN

Lisa Honeyford, RN, MN, CPON

Mari Acebes-Carcao, RN

11/6/2009

 





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