Vascular Access (central venous catheters, tunneled catheters, ports)
Many diseases require intravenous (IV) treatment. Typically an IV catheter is placed in a vein in the hand or arm. In smaller children, IV catheters may be placed in the foot. Intravenous fluids are given to treat or prevent dehydration when patients cannot eat and drink. A large number of medications are given intravenously.
If intravenous therapy is needed for prolonged periods of time (many days, weeks, months, indefinitely) special intravenous catheters may be helpful. There are several varieties of long term intravenous catheters. The examples below include different types of intravenous catheters that are commonly used for long term IV treatment. These special long term intravenous catheters are referred to as chronic vascular access devices (CVADs). Pediatric surgeons at Penn State Children's Hospital place CVADs in infants, children and adolescents who require long term IV treatment. CVADs are usually placed in the operating room, using general anesthesia. The procedures are made safer by using ultrasound and X-ray in the operating room to identify blood vessels and confirm the position of the catheters.
Examples of different CVADs include:
Temporary central venous catheters
There are large veins in the neck, shoulder and groin areas that can be reached by passing a needle through the skin or through small incisions. These CVADS are typically used for one to two weeks.
Tunneled central venous catheters
These CVADs are placed in a similar fashion to the temporary catheters, however the catheter is tunneled under the skin before it exits the body and the portion of the catheter under the skin may have a small fabric cuff. The tunnel and the cuff provide a barrier to infection so that the catheter may be used for many months or even years. We sometimes refer to these CVADs by manufacturer’s names (Broviac catheter).
Tunneled central venous catheter with subcutaneous port
Instead of directly coming out of the skin, the catheter is attached to a “port” that is under the skin. When not in use, there is nothing external, coming out of the patient. To use this CVAD, a special needle is inserted into the port through the skin. The skin becomes less sensitive over time and topical local anesthesia is used to decrease discomfort when the port is “accessed”. We also refer to these CVADs by manufacturer’s name (Mediport).
There are risks associated with CVADs including risks of the procedure itself. The catheter devices do wear out over time and will eventually need to be removed or replaced. Infection is the most common problem with CVADs. Strict adherence to infection reduction protocols during insertion and use of the device lowers those risks.