Maintaining intravenous (IV) access for children requiring chemotherapy is a challenge. There are devices available to make this process easier. The type of device chosen is dependent upon the type and duration of therapy and personal preference.
The two most common types are:
External catheters (also known as: BROVIAC®, HICKMAN®) External catheters are tunneled under the skin and have a dacron cuff. They are surgically placed in a major vessel of the body, most often in the chest. They are called external because a portion of the catheter is exposed which allows usage without a needle stick. It requires a dressing to cover the place where the catheter comes through the skin at all times. The dressing must be changed at regular intervals (policy regarding dressing changes varies by institution). The use of this type of catheter also requires that the family learn to administer heparin to maintain patency. The frequency of heparin administration will be determined by the hospital policy. Family members are taught to do the dressing changes at home between treatments. Showering and swimming need to be avoided while the catheter is in place. This makes an external catheter less appealing to adolescents and young adults.
"HICKMAN and/or BROVIAC are registered trademarks of C.R. Bard, Inc. and its related company, BCR, Inc."
Subcutaneous ports (also known as: mediport, port-a-cath, port, infusaport) These devices are also surgically placed and are totally implanted into the subcutaneous tissue most often on the chest. They have an attached catheter that is inserted into a major vessel. A special "huber" needle needs to be inserted through the skin and into the port prior to its use. This is usually done by a healthcare professional rather than a parent. A numbing agent is generally used prior to the needle insertion that makes it more comfortable for the patient. When it is "accessed" it requires a dressing very much like an external catheter. When not being used, it is out of sight and needs no special care.
Each of the types of catheters is used the same way for giving chemotherapy and other intravenous infusions that are necessary with childhood cancer treatment. Complications are similar for each particular type. The most common complications include: infection and occlusion.
Signs of infection of the catheter can include: fever, redness, tenderness, pain or discharge from the site. Any of these symptoms should be reported to your healthcare team immediately. The heathcare team will evaluate and provide appropriate treatment of the infection.
Occlusion refers to blockage of the catheter by a thrombus or clot. The occlusion can be partial or complete. It will be necessary for the healthcare team to evaluate and treat an occlusion.
Deb Shade, RN, CPON, Penn State Children's Hospital
Reviewed June 2008