If you will be receiving chemotherapy over a long period of time, or if you are a candidate for a blood or marrow transplantation, your healthcare provider may recommend a central line, or central venous catheter (CVC). CVCs may also be called venous access devices (VADs).
CVCs are catheters that are inserted through the veins of your arm or chest, and have a tip that is located in a large vein near your heart called the superior vena cava. These catheters stay in place for long periods of time and allow healthcare providers to give you medications and blood products, and take blood samples without having to repeatedly poke your veins.
There are three main types of CVCs that are used on blood cancer patients. They are tunneled lines, peripherally inserted CVCs (PICC lines), and implanted ports.
What is a Tunneled CVC?
Tunneled CVCs are called by many different names. Broviac, Hickman, Neostar, Leonard, and Groshong are all examples of tunneled CVCs.
Usually, tunneled CVCs are inserted in a surgical suite or in a sterile procedure room. While you will be awake during the insertion, your doctor will likely give you medication to keep you relaxed and comfortable, as well as a local anesthetic to numb the area where the catheter will enter the body.
The physician that is inserting the catheter will make two small incisions on your chest. One will be a few inches above your nipple (called the exit site), and the other will be higher up, just under your collarbone (called the entrance or insertion site). Then, they will make a tunnel under the skin between the two incisions. The CVC is then threaded from the exit site to the entrance site and then into the vein under your collarbone.
The tunnel will heal over time and serve two purposes. First, it makes it difficult for bacteria to climb up the tube and into your bloodstream, and second, it helps to hold the catheter in place.
There will be a dressing applied over the site, and the catheter will require special flushing to keep it in good working order. Your healthcare team will provide you with education on how to look after your tunneled CVC when you go home.
What is a Peripherally Inserted CVC (PICC Line)?
Peripherally inserted CVCs, or PICC lines, are often thought to be very large intravenous sites in the arm. However, although they are inserted into your arm, they are central venous catheters, that is, the end of the catheter lies in a large vein near your heart.
PICCs are usually inserted in a sterile procedure by either a specialized nurse or doctor. During the insertion, you will be awake and alert. The healthcare provider that is inserting the catheter will usually numb the area on the inside of your elbow, or just above there, with a local anesthetic. Sometimes, they will use an ultrasound to get a view of the vein. Then they will enter the vein with a large, hollow needle and thread the catheter through the needle and into the vein.
When the catheter is in place, it may be sutured or secured so it does not get pulled out accidentally. There will be a dressing applied over the site. If you will be going home with your PICC, a family member or caregiver will receive education on how to care for the catheter.
What Are Implanted Ports?
Implanted ports, sometimes called port-a-caths, are small devices with a catheter attached. The device is surgically placed under the skin, usually on the upper chest, and the catheter is threaded into the venous system. When the device is in place, there is no part of the CVC that is outside the body; it is all located under the skin.
When it is time for you to have bloodwork done or medications given, your nurse will access the CVC with a special needle that goes through your skin and into the port. Some patients complain of a pinching sensation when the needle is inserted.
When the implanted port is not in use, there is no dressing required. If you go home with a port, you may need to come back into the hospital or cancer center regularly to have the CVC flushed and maintained.
What are the Advantages to Having a CVC?
- Fewer needle pokes throughout your treatment
- Larger volumes of fluid can be given more quickly
- Some medications are so irritating to the smaller veins of your body that they can only be given through a CVC
What are the Disadvantages of Having a CVC?
- CVCs must be handled with care to prevent infection and complications
- Changes to your body image
- Insertion carries certain medical risks, as with all surgical procedures
- Usually requires maintenance and supplies at home
Questions to Ask Your Healthcare Provider About Your CVC
- Why do I need a CVC?
- How long do you expect I will need to have it?
- What kind of maintenance does it require?
- Where do I get the supplies for it?
- What is the cost to insert and maintain this device?
- What side effects are expected? Which ones should I be worried about?
- Who do I contact if I have questions or concerns?
When Should I Be Worried?
If you have any of the following symptoms or situations, you should seek medical help immediately:
- Sudden shortness of breath
- Chest pain
- Broken or damaged CVC, or a leaking CVC
- Dislodged or partially dislodged CVC
- Redness, swelling or discharge at the insertion site
- Swelling of the neck, arm or face
The Bottom Line
CVCs can make many aspects of the treatment for your blood cancer easier. They are designed for long-term use and provide healthcare providers with access to large blood vessels in your body. In fact, some treatments or therapies require the use of a CVC.
While in many ways having a CVC can be convenient, they are also a portal from the outside world into your blood stream, and do have specific risks associated with them. Preventing infection and knowledge of CVC maintenance are critical to ensure that your catheter is available and safe to use when you need it.
Goodman, M. Chemotherapy: Principles of Administration. In Yarbro, C., Frogge, M., Goodman, M., Groenwald, S. eds(2000) Cancer Nursing: Principles and Practice 5th ed American Cancer Society, Jones and Bartlett: Sudbury, MA.