This page explains about insertion of a central venous catheter (CVC) and what to expect when your child comes to Great Ormond Street Hospital (GOSH) to have this procedure.
What is a CVC?
A CVC is a soft plastic tube which is tunnelled under the skin into a vein in the neck. It is then threaded through the vein into the right side of the heart. A CVC provides easy and reliable access to your child’s bloodstream.
There are many reasons why your child might benefit from a CVC, but the most common reasons are for taking regular blood samples for testing, giving medicines such as chemotherapy on a long-term basis or giving nutrition directly into the bloodstream.
Most long-term CVCs have a cuff or collar around them holding it in place. Over time it becomes embedded under the skin. Some CVCs are only needed on a short-term basis, for instance, after surgery or in intensive care. These do not have a cuff so can be removed more easily.
CVCs can be inserted by a different teams at GOSH, including the Surgical department as well as Interventional Radiology. In Interventional Radiology, CVCs are placed by a variety of operators, such as doctors, specialist nurses and radiographers.
What happens before the procedure?
You will already have received information about how to prepare your child for the procedure in your admission letter. You may need to come to GOSH before the procedure so that your child can have a pre-admission assessment to check that they are well enough. The appointment may involve taking blood samples and other tests.
Often CVC insertion happens while your child is still in hospital. The doctor will explain the procedure in more detail, discuss any worries you may have and ask you to sign a consent form giving permission for your child to have the procedure. If your child has any medical problems, please tell the doctors.
Many of the procedures we perform involve the use of x-rays. Legally, we are obliged to ask any girls over the age of 12 whether there is any chance they might be pregnant. This is to protect babies in the womb from receiving unnecessary radiation.
What does the procedure involve?
Your child will need to have a general anaesthetic for this procedure. It is important that your child does not eat or drink anything for a few hours before the anaesthetic. This is called ‘fasting’ or ‘nil by mouth’. Fasting reduces the risk of stomach contents entering the lungs during and after the procedure.
You will be informed the night before the procedure of the time that your child should be ‘nil by mouth’ – in other words, have nothing to eat or drink before the anaesthetic. Fasting times are provided in your admissions letter – in broad terms, this is six hours for food (including milk), four hours for breast feeding and two hours for clear fluids before the procedure.
It is equally important to keep giving your child food and drink until those times to ensure they remain well-hydrated and get adequate nutrition. This may involve waking your child in the night to give them a drink which we recommend.
Once your child is under general anaesthetic, the operator will use a variety of imaging techniques, such as ultrasound or x-rays, to look for a suitable vein in the neck. Once they have found one, they will inject the area around the vein and the side of the chest with local anaesthetic to make it numb for a few hours.
The CVC is tunnelled under the skin on the chest through a small incision until it is near the neck vein. They then make a small puncture into the neck vein and thread the CVC into it until it reaches the right side of the heart.
The CVC is flushed through with salt water solution (saline) and then ‘locked’ with a liquid called heparin so that clots cannot form inside the tube. The neck incision is covered with a sticky paper stitch which should stay in place for five days or so. The CVC is held in place at the exit site with a stitch and covered with a see through dressing. The exit site is where the CVC comes out through the skin.
Are there any risks associated with the insertion procedure?
The CVC is inserted while your child is under general anaesthetic. Although every anaesthetic carries a risk, this is extremely small. There is a small risk of bleeding. A risk of damage to the lung has been reported but this is very rare with the modern techniques used.
As the CVC gives direct access to the bloodstream, infection can be a risk after the procedure. The CVC may also become blocked, dislodged or fall out, meaning that it will need to be replaced. You will need to look after the CVC very carefully but we will teach you everything you need to know before you leave GOSH.
The nurses will also give you a written information booklet to remind you about what we have taught you.
Are there any alternatives to CVC insertion?
The doctors will only suggest that your child needs a CVC or other central venous access device if they are having frequent or long-term treatment needing access to the bloodstream. If your child only needs injections or blood samples occasionally, a cannula (thin plastic tube) inserted into a vein on the hand or foot each time might be a better option.
There are various types of central venous access device. However, depending on your child’s age and the reason why they need one, some options may not be appropriate. The doctors and nurses will explain the benefits and drawbacks of each available option before you and your child make a decision.
What happens afterwards?
Your child will return to the ward after they have recovered from the general anaesthetic. Some children feel sick and vomit after a general anaesthetic. Your child may have a headache or sore throat or feel dizzy, but these side effects are usually short-lived and not severe.
The area where the CVC was inserted will feel uncomfortable for a while afterwards but this soon passes. The nurses will give your child pain relief as needed. Your child can start eating and drinking as normal once they feel like it. The CVC can be used immediately if required.
The sticky paper stitches at the neck should stay in place for five days or so but will then start to drop off - this is normal. The see-through dressing may need to be changed after 24 hours, particularly if the exit site has oozed after the operation.
If your child does not need to stay in hospital for treatment, you can return home once you are confident in caring for the CVC. Your nurse will provide you with instructions on how to look after the CVC at home. We will also give you a safety pack and teach you what to do if the CVC falls out or breaks.
In the first few days after insertion, you should call the hospital if:
The neck and chest incisions look red, swollen and feel hotter than the surrounding skin.
The incisions are oozing.
Your child is in a lot of pain and pain relief does not seem to help.
Your child has a temperature of 38°C or higher.
Please note this is a generic GOSH information sheet. If you have specific questions about how this relates to your child, please ask your doctor. Please note this information may not necessarily reflect treatment at other hospitals.