Removal of a cuffed Central Venous Catheter (CVC)

The doctors have decided that your child’s CVC needs to be removed. It may not be needed any more or it may not be in the right place. The CVC may also need to be removed because it has become infected, broken or has stopped working. The doctors will explain the reason why they need to remove your child’s CVC.

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. This appointment may involve taking blood samples and other tests.

Your child will need to be admitted to a bed on a ward in the hospital. The person bringing your child to the procedure should have ‘parental responsibility’ for them. Parental responsibility refers to the individual who has legal rights, responsibilities, duties, power and authority to make decisions for a child. If the person bringing your child does not have parental responsibility, we may have to cancel the procedure.

An anaesthetist will visit to talk to you about your child’s anaesthetic. The specialist will explain the procedure in more detail, discuss any questions 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 specialists.

Many of the procedures we perform involve the use of X-rays. Legally, we are obliged to ask anyone over the age of 12 whether there is any chance they might be pregnant, and we will also ask for the first date of their last period (if started). This is to protect babies in the womb from receiving unnecessary radiation.

You and your child will then be brought to the Interventional Radiology (IR) suite within the X-ray department for the procedure to be done.

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. This appointment may involve taking blood samples and other tests.

Your child needs to be fasted for the procedure for the general anaesthetic. If your child takes regular medication, please speak to your child’s team about when to stop these before the procedure.

As a general rule:

Food and milk:

• Breast-fed babies- can have their last feed three hours before the procedure. Breast milk is digested faster than solid food or formula.
• Bottle-fed babies and children- can have their last milk feed, food or milk drink, six hours before the procedure. They should not have any food or milk after this time.

Water:

• All babies and children can have a drink of water (but no other fluids), until one hour 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.

Please follow these instructions carefully, otherwise your child’s procedure may be delayed or even cancelled.

Once your child is under general anaesthetic, the operator (doctor or nurse) will remove the line through the exit site. If there is a stitch holding the CVC in place, they will remove this as well. Most of the time the line will slide out of the exit site easily, but occasionally the cuff that held the line in place remains in the tunnel under the skin. Ideally, the cuff should be removed, especially if the CVC is being removed because it is infected.

The operator will try to remove the cuff through the exit site, but sometimes a second incision needs to be made higher up your child’s chest. This will be closed with dissolvable stitches.

Sometimes, the operator will decide it is safer to leave the cuff in place, but we will always tell you if this is the case. It can be removed at a later stage if it is causing problems. If the cuff is causing cosmetic problems, it can be removed when your child is older.

The operator may inject some local anaesthetic into the area to make it numb for a few hours. Once the CVC has been removed, the exit site will be covered with a dressing and sometimes sticky paper stitches, which should be kept dry for two days after the procedure.

Occasionally, the operator may choose to close the exit site with one or two stitches that will dissolve over the next few weeks.

Your child will be having the procedure under general anaesthetic. Every anaesthetic carries a risk, but this is extremely small.

There is a small risk of bleeding when the CVC is removed but this is minimized by applying pressure to the area for a few minutes afterwards. Very rarely the CVC breaks while it is being removed leaving a portion inside the vein or skin tunnel. If this occurs, the operator will try to remove it safely during the same procedure. If the broken portion cannot be removed safely at this point, they may suggest taking it out during a second procedure at another date. Rarely, the operator may decide that it is safer to leave a small piece of the line behind rather than carry out a bigger operation to try to remove it.

The procedure may involve the use of X-rays. The levels that are used are low dose and therefore low risk. If you have any concerns regarding the use of radiation, please discuss this with the person performing your procedure beforehand.

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 removed 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.

If your child does not need to stay in hospital for treatment, you can return home. Due to the risk of infection, children are not allowed to keep their CVC as a souvenir after it has been removed.

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 with blood or pus.
• Your child is in a lot of pain and pain relief does not seem to help.
• Your child has a temperature of 38⁰C or higher.

You can call the ward by calling the GOSH switchboard and asking for the ward your child was discharged from.

Telephone: 020 7405 9200

If you are unable to get through, please call NHS111 by dialling 111.

If you have any questions, please speak to you child’s doctor or nurse or call Interventional Radiology:

Telephone: 020 7405 9200

You can also contact us through MyGOSH.