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January Article 2016: Venous Catheters for Children with Cancer

January 28, 2016


One of the first decisions parents have to make after their child is diagnosed with cancer is what type of venous catheter to use. Whether your child has leukemia, a brain tumor, neuroblastoma, osteosarcoma, Wilms tumor, or another type of childhood cancer, he or she will probably need intensive treatment. For most childhood cancers, treatment includes surgery, chemotherapy, intravenous (IV) fluids, IV antibiotics, blood transfusions, frequent blood sampling, and sometimes IV nutrition. Venous catheters are used to reduce stress and discomfort for the child by eliminating the need for hundreds of needle sticks.

The three types of venous catheters are external catheters, subcutaneous ports, and peripherally inserted central catheters (PICC). Other names for a venous catheter include venous access device, right atrial catheter, implanted catheter, indwelling catheter, central line, Hickman®, Broviac®, PORT-A-CATH®, and Medi-port®.

This article provides a brief overview of each kind of catheter.

Venous Catheters - External Catheter

External Catheter

An external catheter is a long, flexible tube with one end located in the right atrium of the heart and the other end outside the skin of the chest. The tube tunnels under the skin of the chest, enters a large vein near the collarbone, and threads inside the vein to the heart. The tube that channels the fluid is called a lumen. Some external catheters have double lumens in case two drugs need to be given at the same time.

Because chemotherapy drugs, transfusions, and IV fluids are put in the end of the tube hanging outside the body, the child feels no pain. Blood for complete blood counts (CBC) or chemistry tests can also be drawn from the end of the catheter. With daily care, the external catheter can be left in place for years.

Venous Catheters - Subcutaneous Port

Subcutaneous Port

The subcutaneous port differs from the external catheter in that it is completely under the skin. A small metal chamber (1.5 inches in diameter) with a rubber top is surgically implanted under the skin of the chest. A catheter threads from the metal chamber (portal) under the skin to a large vein near the collarbone, and then inside the vein to the right atrium of the heart. Whenever the catheter is needed for a blood draw or infusion of drugs or fluid, a needle is inserted by a nurse through the skin and into the rubber top of the portal. Usually a drug that numbs the skin (e.g., EMLA®) is used to make the needle insertion pain-free.

Venous Catheters - Peripherally Inserted Central Catheter (PICC)

Peripherally Inserted Central Catheter (PICC line)

A peripherally inserted central catheter is also referred to as a PICC line. This type of catheter is placed in the antecubital vein (a large vein in the inner elbow area) and is threaded into a large vein above the right atrium of the heart (see Figure 13-4). Unlike other catheters, a PICC line can be inserted by an IV nurse rather than a surgeon.

The PICC line can remain in place for many weeks or months, avoiding the need for a new IV every few days. It can be used to deliver chemotherapy, antibiotics, blood products, other medications, and IV nutrition. When the PICC line needs to be accessed, an IV line is connected to the end of the catheter. When it is not in use, the IV is disconnected and the catheter is flushed and capped.

Making a Decision

After getting information about your options, talk with the doctor about the merits of each type of catheter and ask for his opinion. Talk about the pros and cons with your child if he or she is old enough. Then make the rounds on the oncology unit, asking both parents and children which type of catheter they chose and why. You will probably hear many opinions about the benefits and drawbacks of each type of catheter.

The nurses in the clinic and on the unit are another source of valuable information. They will have seen dozens (or hundreds) of children with catheters, and they can give excellent advice. There is no right or wrong choice, just different options for each unique child.

. . . . .

My 4-year-old daughter Christine loved ballet and was extremely interested in her appearance. Her younger sister was very physical, and we were worried that if we chose the Hickman® her toddler sister would grab and pull on the tubing. We chose the PORT-A-CATH® so that Christine could wear her tutus without reminders of cancer, and so the children could play together without mishap.

. . . . .

We chose the Hickman® for Sam because we didn’t want any needles coming at him. He spent almost the whole first year in the hospital, so it saved him from so many pokes. The line was a blessing. He went 3 years and 3 months with no infections. We thought it was just a beautiful thing.

. . . . .

We didn’t get a choice when my daughter needed a stem cell transplant. They needed to put in two Broviac® lines to accommodate all of the meds, fluids, and TPN [total parenteral nutrition] she needed for the procedure. I remember seeing six bags hanging up at once. I did the dressing changes, and we didn’t have any trouble with the lines throughout her recuperation.

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© 2016 Nancy Keene
Permission is required from the publisher (info@childhoodcancerguides.org) to use the content in this article for any purpose.
For much more information about external catheters, read Chapter 9 in Childhood Brain and Spinal Cord Tumors: A Guide for Families Friends and Caregivers, 2nd ed. by Tania Shiminski-Maher, Catherine Woodman, and Nancy Keene

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