DOCSLIB.ORG

Your Child: Lines, Tubes and Ports This Publication Is Intended to Supplement the Advice Given by Your Child’S Medical Team

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Your Child: Lines, Tubes and Ports This Publication Is Intended to Supplement the Advice Given by Your Child’S Medical Team Grace Kelly Childhood Cancer Trust Your child: Lines, tubes and ports This publication is intended to supplement the advice given by your child’s medical team. It was written by Dr Jennifer Kelly, GP and founder of the Grace Kelly Childhood Cancer Trust. Our thanks go to Dr Bob Phillips (Honorary Consultant in Paediatric Oncology, LTHT), Professor Bernadette Brennan (Paediatric Oncology, Manchester), Dr Laura Roe (Consultant Paediatrician with a special interest in oncology and palliative care, UHNM), Evelyn Ward (Clinical Dietetic Manager, LTHT), Alix Dunlop-Jones (Senior Paediatric Dietitian, LTHT), Linda Sanderson (Nurse Educator for CLIC Sargent, Leeds) and Dominique Miller (Paediatric Dietician, UHNM) for their help in the peer review of this resource and to Allison Semikin for her help as a parent reviewer. The Grace Kelly Childhood Cancer Trust has made every effort to ensure information is accurate at the time of printing. We are unable to accept responsibility for any information provided by third parties. If you would like more information on the references used to make this publication, please contact us. The publication of this booklet was funded by the Grace Kelly Childhood Cancer Trust and produced following the guidance of the Information Standard. Copyright GKCCT 2019. Published May 2019. Next review due in May 2022. About this booklet If you are reading this, the likelihood is that your child, or a child close to you, has been diagnosed with cancer. This booklet is designed to be an information summary and to answer some of your questions. If you have any queries, please discuss them with your healthcare team. When a child is diagnosed with cancer you suddenly have to make decisions about things you previously knew very little about. This booklet has been written to help give you more information and to answer some of your questions. We have also included a section on useful tips from parents whose children have experienced some, or all of these devices. At the back of the booklet, there is a glossary of terms for more information. Words that are included in the glossary are highlighted in bold in the main text. 2 www.gkcct.org Central access When a child is diagnosed with cancer, they are usually fitted with a special line or port through which most of their treatment can be given. These devices are called central vascular access devices. These devices mean that blood tests and treatments (such as chemotherapy) can be done as safely and as efficiently as possible whilst causing the least upset to you and your child. There are various devices available, but the main types are central venous catheters, vascular ports and peripherally inserted central catheters. The most suitable device for your child will depend on their age, size and the reason they need to have one. Doctors will only Central Venous Catheters suggest the use of central venous access devices if your child needs frequent or Children with cancer are usually fitted with long-term treatment that needs regular a central venous catheter through which access to their bloodstream. they receive their treatment. There are three main types: central lines, vascular access ports and picc lines. Your child: Lines, tubes and ports 3 Central lines Once in place, if your child does not need to stay in hospital for treatment, you can return Often known as a HickmanTM Line, home. Your child’s care team will provide BroviacTM line, central line or wiggly, this is you with instructions on how to care for a soft thin tube (catheter) that is inserted your child’s line at home. They will usually whilst your child is under a general contact your child’s community nursing anaesthetic. It is inserted into a large vein team who will help you to care for your in the neck and then tunnelled under the child’s line. Usually this involves a weekly skin to come out on the chest wall below dressing change and flushing of the line. the collar bone. When your child wakes, they will have two tiny incisions. The first is in the neck and A central venous catheter is usually closed with paper stitches, and gives direct access to the the second is where the line comes out. blood stream so care for the This is held in place by a stitch and a see- line is very important, to limit through dressing. the chances of infection. A central line is designed to give long term venous access for your child. Although this sounds daunting, your child will soon adapt to having a central line. Many children can appreciate their line because they understand it reduces the need for blood tests and cannulas. Although it looks like only one line, a central line actually contains two (or very occasionally three) tubes which divide out into two (or rarely three) ends to allow more than one medication to be given at a time. This makes giving treatment that little bit easier. 4 www.gkcct.org Vascular Port Also known as an implantable port or portacathTM, this device is placed under the skin in the chest. It consists of a small chamber with a catheter attached. This catheter is then threaded under the skin and into a large vein. The port gives easy and reliable access to your child’s bloodstream and sits just below the skin. A vascular port is fitted when your child is under a general anaesthetic. When they wake up, they will have two small incisions: one by the port site and the other in the Once accessed, a port can be used for up neck where it was inserted into the vein. to a week at a time so there is no need for a separate needle for every procedure. When a treatment cycle is finished, the needle is removed (the port is de-accessed). This is a simple procedure undertaken by trained staff; the needle just pulls out of the port. To use the port (to access the bloodstream), a special type of needle is inserted through the skin into the chamber in the vascular port. The skin where the needle is inserted can be numbed using a local anaesthetic cream or cold spray. Usually a port only has one chamber, but it is possible to have a port with two chambers (lumens) which would allow more than one infusion to be run at the same time. How a port may look once the site of insertion has healed What is pain? Pain is an unpleasant feeling that can occur as a result of an injury, Why it is important to target pain illness or medical procedure. You do not need to see physical damage to Pain is a symptom that most children have pain and it can affect infants will find distressing. When pain is not and children of all ages. adequately controlled it has a big impact on how happy your child is and Very young children and those with causes anxiety for you both. Assessing disabilities may find it difficult to tell us and managing pain appropriately about their pain, so we use a number of makes a huge difference to your child’s Please see our booklet “Managing your child’s pain,” for further advice ways to assess the amount of pain they experiences and allows your child to play are experiencing. and “be a child”. Why do children with cancer experience pain? Children with cancer can experience pain on pain management during needle procedures for your child. for a number of reasons. Both cancer itself and the treatments that your child needs to undergo may cause pain. Blood tests and other procedures, surgery, chemotherapy and radiotherapy can all result in pain. Each child is unique in how they experience pain so every effort will be madeGrace by your Kelly child’s team to minimise the pain theyChildhood experience. Cancer Trust Managing your child’s pain Managing your child’s pain 3 Your child: Lines, tubes and ports 5 Which Device should we choose? Dependent on the age and size of your child and the type of treatment they require, they will usually be offered a central line of some sort. Certain treatment regimes are better suited to a certain device so your child’s care team will help to guide you as to which device is most suitable for your child. Hickman line Vascular port Accessing the line No need for a needle to Requires a needle to access (taking a blood sample) access the line and can the line. This can be made be accessed even when easier with numbing cream sleeping. Excellent for a but can be distressing for child distressed by needles. some children. Bathing Bathing in a shallow bath Once healed and not only and the line needs to be accessed, there are no issues taped out of the way. with bathing. Swimming No swimming due to Once healed and not infection risk unless using a accessed, swimming is specialised dry suit. possible in between treatment courses. Dressings Weekly dressing changes Once healed and not required. These can be accessed, there is no need distressing for some children. for dressings. 6 www.gkcct.org Hickman line Vascular port Infusions Easier to run multiple More challenging to run infusions if a lot of multiple infusions unless a medications are needed. double lumen port is used. Emergencies Must take emergency Unless port is accessed, dressings and clamps with special emergency you wherever you go. equipment not required. Physical activity Greater limit to physical Participation in physical activities due to risk of activities is easier but contact damaging lines.
Load more

Recommended publications
  • What Is a Portacath? Fade Over Time
    Factsheet Issued February 2016 Portacaths the other around 3cm, both of which should What is a portacath? fade over time. A port-a-cath (also known as portacath, port or Afterwards, you will be able to feel the device implanted port) is a small medical device that under the skin and you may see a small bump provides direct access to a central vein. where the port is situated. A portacath is usually made of surgical steel or What is a portacath used for? Who might titanium, and is around 2.5 to 4cm in diameter. benefit from it? The head of the port has a rubbery membrane that is self-sealing, meaning that it has a long A portacath may be considered if you need life allowing it to be accessed time after time. frequent access to veins for blood, Attached to the port is a flexible tube injections/medical treatment(s) and/or (catheter), the tip of which will be positioned because of problems with access to smaller inside a large vein somewhere near to the veins. Portacaths are therefore considered for heart (see below). acute porphyria patients who need repeated intravenous treatment – specifically haem The port will be positioned just underneath the arginate – which needs to be administered via skin, in the upper chest or upper arm. The a large vein in order to avoid inflammation, surgical team may use a Doppler (a special pain and possibly long-term damage to smaller ultrasound) to determine the exact position (peripheral) veins. which will be chosen based on the best vein available.
    [Show full text]
  • 018 – Guidelines for the Management of Central Venous Catheters (Cvc) in Oncology and Haematology Adults
    018 – GUIDELINES FOR THE MANAGEMENT OF CENTRAL VENOUS CATHETERS (CVC) IN ONCOLOGY AND HAEMATOLOGY ADULTS Broad Recommendations / Summary These guidelines are to ensure the safe care and management of Oncology and Haematology adult patients who require a central venous catheter (CVC). The guidelines have been adapted from the former North East Yorkshire and Humber Clinical Alliance (Cancer) NEYHCA CEG – Guidelines for the Management of Central Venous Catheters (CVCs) in Adults, version 2.2 March (2011) - formally HYCCN. NEYHCA has since ceased to exist as has administration or version control facilitation. Therefore, the adapted, updated guidelines are to rebrand and publish directly onto the local HEY Trust Intranet Site and linked to the Queens Centre for Oncology and Haematology; Cancer Services and Chemotherapy CNS Team Website to ensure up to date best practice In 2003 NICE undertook a detailed literature review focusing on how to minimise infection in CVC, its search noted the robust guidelines developed by Pratt et al (2001) known as the epic guidelines, NICE (2003) based their recommendations upon the epic guidance. The epic 2 guidelines focused upon prevention of infection (Pratt et al 2007). It is recognised that there are other issues that needed addressing in relation to the management of CVC’s such as management of blocked lines and educational requirements of both patients and staff. The Royal College of Nursing issued ‘Standards for Infusional Therapy’ November (2005i). This document provided further evidence to inform these guidelines. NB: For full local procedural resource folder please see the Chemotherapy Nurse Specialist Team intranet web-site. 1 PURPOSE / LEGAL REQUIREMENTS / BACKGROUND The Manual of Cancer Standards (DoH 2011) states that common guidance for the ‘care of aids to venous access such as Hickman lines’ should be available.
    [Show full text]
  • Insertion of a Hickman Line
    Insertion of a Hickman Line Information for parents and carers Children’s Hospital, Kamran’s Ward Page 2 This leaflet explains: • what a Hickman line is • why one is necessary • what to expect when your child comes in for their Hickman line to be inserted. What is a Hickman line? A Hickman line is a long, hollow plastic tube made from silicon rubber. One end of the line is inserted through the skin on the chest. The line is then placed into a large vein above the heart. This type of line is often referred to as a ‘central line’. The other end of the line comes out of the body at an ‘exit’ site. It is held in place by a small felt cuff, which is attached to the Hickman line and sits under the skin, as well as a stitch on the outside of the body. The stitch will be removed after 6 weeks. The visible part of the line has a small clamp on it to keep it closed when it is not being used. The line may have 1 or 2 ends (lumens) depending on the treatment your child needs. These ends are sealed with removable bungs. Image: kind permission from Macmillan Cancer Support Page 3 Why does my child need a Hickman line? A Hickman line allows us to take blood for testing and to give your child medicines without the need for needles or cannulas. Some medicines (such as chemotherapy), blood transfusions, antibiotics and other intravenous fluids can all be given easily and more safely through a Hickman line, rather than using the temporary cannulas that are usually placed in the back of the hand.
    [Show full text]
  • Radiology Department Hickman Line Information Leaflet
    Patient Information Radiology Department Hickman Line information leaflet Why do I need this procedure? A Hickman line is a simple, pain free way for nurses and doctors to give you medications or nutrients. It means you can avoid a needle puncture every time you have treatment, which can be uncomfortable and stressful. Doctors recommend the use of a Hickman line for patients who regularly have chemotherapy, long-term antibiotics and infusions. It can remain in place for a long period of time so it can be used throughout your treatment. What is a Hickman Line? A Hickman line is a long, hollow tube made from silicone rubber inserted in one of your neck veins. The space in the middle of the tube is called the lumen. Sometimes the tube has two lumens. This allows different treatments to be given at the same time. At the end of the tube outside the body each lumen has a special cap to which a drip line or syringe can be attached. Sometimes there is also a clamp to keep the tube closed when it is not being used. You might hear Hickman line referred to as a ‘line’, ‘central line’ or ‘tunnelled line’. The procedure will be performed by a radiologist (a specialised X-ray doctor) who will be assisted by a radiographer and a radiology nurse. It is not always easy to predict how long the procedure will take. As a guide, expect to be in the Radiology Department for about one hour. Are there alternatives to having the line inserted? The alternative would be either repeated needle punctures every time you have treatment or a different type of line such as a PICC line.
    [Show full text]
  • Tunnelled Central Venous Access Devices (Hickman) Care Policy for Adults
    TUNNELLED CENTRAL VENOUS ACCESS DEVICES (HICKMAN) CARE POLICY FOR ADULTS Compiled by: Sue Currier, Haematology Nurse Specialist In consultation with: Infection Prevention and Control Team Status: Approval date: December 2011 Ratified by: Clinical Governance Committee Review date: May 2020 Current Version is Vol 7 First Ratified Reviewed held on the Issue 2 Page 1 of 15 Control of Infection Dec 2011 May 2020 Intranet History Issue Date Issued Brief Summary of Change Approved by 1 Dec 2011 New policy Clinical Governance Committee 2 Aug 2013 Re-established as a standalone policy instead of CVAD Policy For more information on the status of this Ann Birler, Nurse Consultant/Deputy Director of document, please contact: Infection Prevention and Control Policy Author Sue Currier, Haematology Nurse Specialist Date of issue Dec 2011 Review due March 2020 Ratified by Clinical Governance Committee Audience All Trust staff Current Version is Vol 7 First Ratified Next Review held on the Issue 2 Page 2 of 15 Control of Infection May 2009 March 2019 Intranet ASHFORD & ST PETER’S HOSPITALS NHS FOUNDATION TRUST TUNNELLED CENTRAL VENOUS ACCESS DEVICES (HICKMAN) CARE POLICY FOR ADULTS 1. INTRODUCTION Bloodstream infections associated with intravascular access devices are potentially among the most dangerous complications of healthcare that can occur, worsening the severity of the patients underlying ill health, prolonging the period of hospitalisation and increasing the cost of care. Almost 64% of patients in the UK with an intravascular device acquire a catheter related bloodstream infection (CR-BSI) (HPA 2012). 2. PURPOSE The number of patients requiring central venous access continues to grow as the management of disease and trauma improves and life expectancy is prolonged.
    [Show full text]
  • Clinical and Cost-Effectiveness of Hickman Line Insertions in Adult Cancer Patients by Nurses
    Health Technology Assessment 2003; Vol. 7: No. 36 Methodology A randomised controlled trial to evaluate the clinical and cost- effectiveness of Hickman line insertions in adult cancer patients by nurses A Boland A Haycox A Bagust L Fitzsimmons Health Technology Assessment NHS R&D HTA Programme HTA HTA How to obtain copies of this and other HTA Programme reports. An electronic version of this publication, in Adobe Acrobat format, is available for downloading free of charge for personal use from the HTA website (http://www.hta.ac.uk). A fully searchable CD-ROM is also available (see below). Printed copies of HTA monographs cost £20 each (post and packing free in the UK) to both public and private sector purchasers from our Despatch Agents. Non-UK purchasers will have to pay a small fee for post and packing. For European countries the cost is £2 per monograph and for the rest of the world £3 per monograph. You can order HTA monographs from our Despatch Agents: – fax (with credit card or official purchase order) – post (with credit card or official purchase order or cheque) – phone during office hours (credit card only). Additionally the HTA website allows you either to pay securely by credit card or to print out your order and then post or fax it. Contact details are as follows: HTA Despatch Email: [email protected] c/o Direct Mail Works Ltd Tel: 02392 492 000 4 Oakwood Business Centre Fax: 02392 478 555 Downley, HAVANT PO9 2NP, UK Fax from outside the UK: +44 2392 478 555 NHS libraries can subscribe free of charge.
    [Show full text]
  • Central Venous Catheters
    n The Leeds Teaching Hospitals NHS Trust Yorkshire Regional Centre for Paediatric & Adolescent Oncology and Haematology Central venous catheters Information for parents 2 Introduction Your doctor has advised you that your child needs to have a central venous catheter (CVC). These are often referred to as tunnelled catheters or implanted ports. Other names that you might hear them being called are Hickman Lines, Broviac Lines or Portacath. This booklet has been written to help you understand a little more about CVC’s and why your child needs one. The first part of the booklet describes what they are and how they are put in. The second part of the booklet tells you how to care for the line and answers some frequently asked questions We recognise that you may be feeling anxious about your child having a CVC put in. Please talk about any worries or concerns that you may have to a member of the team caring for your child, they are there to support you and answer any questions you may have. Why does my child need to have a central venous catheter? CVC’s are usually inserted when a child needs long term access to a vein during their care. This might be for: • Medication • Special intravenous feeding • Fluids • Blood and blood product transfusions • Blood tests 3 Having a central line may mean your child will not need as many needles over the course of their treatment. However not all blood tests can be taken from a central line, so it is important not to promise your child that they will never have another needle.
    [Show full text]
  • What Is a Hickman Line? Feel Nauseous
    What happens next? How is it removed? Nuffield n We will take an X-ray of your chest to make sure the You will need a blood test before your line is removed Orthopaedic line is in the correct place. The doctor will check this by the CNS or doctor. before using the line. Centre The line sticks to the underlayer of skin so it is not NHS Trust If you have been given sedation, you will be sleepy easily pulled out and needs to be gently released. The and a nurse will look after you until you recover. It is area around the line will be cleaned and then made important that you stay lying down for about an hour numb with a small injection of local anaesthetic. This as some people feel unsteady. stings a little. A small cut is made in your skin. This allows the line to be released. There may be oozing from around the insertion site. This is normal and further dressings can be applied. You will feel a little pressure but it will not hurt. Once the cuff is free the line comes out easily. Then gentle It is normal to feel a little discomfort or ache at the pressure is applied over the cut as well as one or two site of the line and your shoulder for 24 hours. Mild stitches. painkillers will settle this. Should you develop a dry cough, become breathless or experience excessive The stitches will have a dressing over them and this pain, you must tell the nurse.
    [Show full text]
  • Guideline for Clinical Staff On: Hickman / Broviac Catheter in Olchc
    GUIDELINE FOR CLINICAL STAFF ON: HICKMAN / BROVIAC CATHETER IN OLCHC Version Number V1 Date of Issue June Reference Number GCSHBC-07-2017-HOSCS-V1 Review Interval 3 yearly Approved By Signature: Date: July 2017 Name: Fionnuala O’Neill Title: Nurse Practice Coordinator Authorised By Signature: Date: July 2017 Name: Rachel Kenna Title: Director of Nursing Author/s Name: Haematology/Oncology shared care service Location of Copies On Hospital Intranet and locally in department Document Review History Review Date Reviewed By Signature 2020 Document Change History Change to Document Reason for Change ACKNOWLEDGEMENT This guideline has been taken form the supportive care guidelines for Haematology/Oncology and has been agreed for use in OLCHC for the care of children with Hickman/Broviac catheters. The NPC wish to acknowledge the Haematology/Oncology team. Introduction Central Venous Access Devices (CVAD), is a broad term used to include many catheter types which are inserted into a peripheral/central vein in the body to deliver medications or other therapies to children. A catheter has one end positioned outside the body while a port is surgically placed under the skin and requires a special needle to access it. The most common CVADs include: Peripherally Inserted Central Catheter inserted into one of the peripheral veins in the upper arm. Central Venous Catheter Implanted Ports inserted into the subclavian or vein or jugular and attached to a fluid reservoir placed in a surgically created subcutaneous pocket in the upper chest or into an arm vein. Hickman / Broviac catheter Permcath-Vascath Catheter Umbilical Venous Catheter Haematology/Oncology Supportive Care Guidelines Page 2 of 41 CONTENTS Page Number 1.0 Introduction – Hickman / Broviac 2 2.0 Commonly used reference tables Table 1….
    [Show full text]
  • Central Venous Access Devices
    CENTRAL VENOUS ACCESS DEVICES. BETHANY COLTON Aims and Objectives • To know what central venous access devices (CVAD) are. • Types of CVADS used in haematology. • To understand why we use them • To know the complications of CVADS • And how to maintain the care of a CVAD What is a cvad? • CVAD`S are IV catheters that terminate in the Superior Vena Cava just above the right atrium. • Short term CVAD`S are in place days to weeks. • Long term CVAD`S are in place weeks to years. What sort of line is this? PICC LINE – Peripherally inserted central line. What sort of line is this? HML – Hickman line What sort of line is this? Apheresis Line - Double lumen tunnelled line. HML PICC LINE Why do we use them IV therapy > 7 days Poor venous access Hyperosmolar solution (TPN) Infusions of vesicant or irritant chemotherapy Stability of patient requires multiple venous access sites or central venous access How are HML and PICC lines similar • Tip placement in superior vena cava • Catheter material is soft & flexible • Require use of a 10ml or larger syringe • Radiological placement verification • Patency check prior to use • Require positive pressure Advantages • Irritant drugs and fluids can be infused without damaging vein walls. • Enable rapid and reliable IV administration of drugs and fluids. • Increased bio-availability (Give concentrated meds safely e.g. Potassium). • Multiple lumens allows 2 or more incompatible drugs or fluid to be administered simultaneously • Easy blood sampling • Can be used for long term access Disadvantages • Potential insertion complications; • Requires nursing staff to be trained • IV drug administration, requires added knowledge • Increased risk of systemic infection, bleeding, thrombosis & air embolism • Patient discomfort / immobility Complications of CVADS • Occlusion • CVAD related infections • Phlebitis, oedema, cellulitis (PICC) • Venous air embolism • DVT INFECTION Treating line associated infections are important and if not treated, can be life threatening.
    [Show full text]
  • What Is a Hickman Line?
    What is a Hickman line? A Hickman line is a thin, long silicone catheter that is inserted through one side of the chest area and threaded via a large vein to a place near your heart. The line has 2 or 3 openings called lumens that allow the simultaneous administration of different medications. Each lumen is sealed off with a needle-free connector at the end and has a clamp along the line to control the flow of medication or to close the line when not in use. The insertion is performed under local anaesthetic. After the procedure, you will be able to go home with the Hickman line on the same day, and the line can be left in place for weeks or months until you complete your treatment. 1 What are the benefits of having a Hickman line? It is recommended for long-term treatments that require: ● Frequent administration of intravenous (IV) therapies such as chemotherapy. ● Frequent taking of blood samples. ● Direct administration of medicines into the central vein. The benefits of having a Hickman line in place include: ● Reducing the discomfort, pain and damage to the veins caused by these long-term treatments. ● You will not need to be injected by needles every time you have treatment or when blood samples are required. What are the risks and complications of having a Hickman line? While a Hickman line is generally very safe, there are still potential risks and complications. Risks during insertion: ● Discomfort or pain caused by the local anaesthetic. ● Blood infection. ● Bleeding due to accidental puncturing of an artery.
    [Show full text]
  • Leukemia Education Package.Indd
    Leukemia Education Package and Your Care Needs During Treatment In this booklet, you will learn about: • Leukemia and your treatment options • How to prevent infections • How to manage your symptoms and side-effects • How to manage your Central Venous Access Device (CVAD) • Where to find support • Who to contact Patient and Family Education Adapted from the “Leukemia Education Awareness Package (LEAP)” with permission from the University Health Network Patient and Family Education Program. Additional information adapted from The Ottawa Hospital. Table of Contents Dealing with Emergencies........................................................................................................................................... 4 What is Leukemia? ............................................................................................................................................................... 6 What are the Treatments for Leukemia? .................................................................................................. 7 Understanding your Blood Work ........................................................................................................................ 8 Complete Blood Counts .................................................................................................................................. 8 Electrolytes and Biochemistry Tests .............................................................................................10 Importance of Fever and Febrile Neutropenia ...............................................................................11
    [Show full text]