About Your Child’s Hickman or Broviac Central Line

Hickman and Broviac catheters allow for your child to get fluids and nutrition through their vein while still giving them freedom to move and be active.

What is a A central line is an IV (intravenous) line that is surgically placed into a large central line? (central) blood vessel of the body. Two very common types of central lines are called Hickman and Broviac catheters. They are placed into a major blood vessel in or near the heart. Part of the line goes under the skin and enters a blood vessel several inches away. This type of central line is called a tunneled central line. The tunneled central line has a cuff under the skin near the exit site. The cuff is a small felt-like piece of material that encircles the central line. Skin will grow around the cuff just inside the body to help hold the line in place and help from it getting pulled out. The cuff also acts like a barrier to decrease the chance of infection. The other end of the tubing remains outside the skin and has an opening for placing IV nutrition, medicines and fluids.

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To Learn More Free Interpreter Services • Intestinal Rehab Program • In the hospital, ask your nurse. 206-987-5662 • From outside the hospital, call the • Ask your child’s healthcare provider toll-free Family Interpreting Line, 1-866-583-1527. Tell the interpreter • seattlechildrens.org the name or extension you need.

About Your Child’s Hickman or Broviac Central Line

Why is a central A central line is used for giving medicine, fluids, IV nutrition and for drawing line used? blood. • It decreases the number of needle punctures needed for IV medicines and lab draws. • It can be used for a much longer time than usual IV lines. • It allows more freedom of movement. IV fluids/medicines can go with you where you go.

Safe care • Keep the central line dry. Protect the line during bathing. You can cover the guidelines site and tubing with plastic wrap such as Saran Wrap, Glad Press ‘N Seal, or a plastic bag taped to the chest to keep water from getting into the central line. at home • Avoid pulls or tugs on the central line, and use the securing device to keep the line in place. Babies and toddlers should wear a one-piece undergarment (like a Onesie) to protect the line. • Avoid lifting up your child under the arms for the first two months after the line is in place. • Older children need to avoid activities that could damage the line, like contact sports. If your child has strong interest in playing sports, talk to your medical team about what they can or cannot do. • Your child can return to school with a central line in place. Make arrangements with a school nurse to discuss how to care for the line while at school. • Keep an emergency kit with your child at all times. The emergency kit should have chlorhexidine wipes, tape, a clamp, gloves, antibacterial ointment and gauze.

Possible Some problems can happen and are listed below. problems with a central line

Skin infection A skin infection at the central line site is possible if there is: • Redness • Drainage • Pain • Swelling • Warmth

Blood infection A blood infection at the central line site is possible if there is: • Fever • Chills • Sweating • Drowsiness or dizziness • A sick feeling • Vomiting

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Difficulty flushing • Observe the catheter for kinks and closed clamps. If the catheter is kinked under the dressing, change the dressing. • Blood back-up in the catheter could occur: This is NOT an emergency. Flush with saline and heparin. • Call Home Care Services if you are still unable to flush.

Leaks It is possible to get a hole or tear in the central line tubing under the skin and central line tubing outside the body. You may be able to see the hole or tear. There could also be damage that you cannot see. Signs of damage could include: • Leaking of fluid from the tubing when flushed • Wetness under the central line dressing or along the tubing • An area of bulging or bubbling on the central line • A pink area on the central line that does not clear with flushing • Puffiness or swelling on the skin near the central line

Catheter comes If the catheter accidently comes out: out 1. Hold firm pressure over the site for at least 10 minutes. 2. Apply antibacterial ointment and cover with gauze and tape. 3. Call the clinic and home care nurse. 4. Get prepared to bring your child in to the hospital to be admitted for central line replacement and possible IV fluids for hydration.

How do I • Wash your hands before doing any central line care. prevent • Always keep a clean and dry dressing over the central line site. problems with • Place a safety loop with extra external tubing under the dressing. a central line? • Follow the instructions for cleaning the cap and using sterile equipment. • Avoid tugs or pulls on the central line. Take extra care when removing clothing to avoid pulls or tugs. • Secure the central line to your child’s body with clips. For younger children, use one-piece outfits to cover the central line. • Always keep scissors and all sharp objects away from the line. • If the central line is hard to flush, do not try to force it.

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Warning signs Call the doctor or nurse in clinic for any of the signs of problems above, and for: to call the  Fever of 101.5 F or above clinic or nurse  Chills, sweating, drowsiness and feeling sick  Trouble breathing or chest pain  Any redness, swelling, pain or drainage around the central line insertion site  Feeling that something isn’t right in the chest area  Bulging or bubbling area on central line or wetness under dressing  Difficulty flushing the line, or in unable to flush the line at all.  Medicine/IV pump malfunction or continued alarms.

Telephone Nurse/clinic ______Phone ______numbers Home care nurse ______Phone ______

To reach the GI Transplant provider on call, phone 206-987-2000.

Seattle Children’s offers interpreter services for Deaf, hard of hearing or non-English speaking patients, family members and legal representatives free of charge. Seattle Children’s will make this information available in alternate formats upon request. Call the 11/19 Family Resource Center at 206-987-2201. This handout has been reviewed by clinical staff at Seattle Children’s. However, your child’s PE2430 needs are unique. Before you act or rely upon this information, please talk with your child’s healthcare provider.

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Patient and Family Education | Gastroenterology 4 of 4