MEDICAL BLOGS:CENTRAL VENOUS CATHETERS ( CVC ) IN CANCER TREATMENT

These central catheters or lines are used in cancer patients for administration of the following:

·      To give chemotherapy or other medicines.

·      To give blood transfusion or platelets.

·      To give fluids or nutrients ( parental nutrition in the form of IV lipids, amino acids etc).

·      They may be used for collection of blood samples for lab testing.
                                 

ADVANTAGES OF CENTRAL VENOUS ACCESS

·      It is pain free

·      Multiple pricks are no longer required.

·      No need to search for veins in the arms or legs.

·      Can administer more than one drug at a time.

·      No chance of leak of chemo drugs under the skin with damage to tissues.

·      Useful for continuous infusions.

·      Can take treatment at home.

·      Useful for long term treatment over many months, which us required in many chemo protocol regimens

·      Replaces the regular IV catheters which can stay for few days only and need to be changed frequently.

·      The central venous catheter is a bigger and longer catheter which is inserted into a large vein in the chest or upper arm.

·      It stays in as long as one needs to get treatment.

·      Some types of CVCs can stay in for weeks, months, or even years.

·      Your cancer care team can help you decide if you need a CVC and the right type of CVC for you.

·      CVC is required because the veins in their hands and arms aren’t going to be able to be used to complete the planned chemo.

The type of CVC you need depends on:

·      How long you’ll be getting treatment

·      How long it takes to infuse each dose of chemo

·      How many drugs need to be given at once

·      Your preferences

·      Your doctor’s preferences

·      The care required to maintain the CVC

·      Cost

·      Other medical problems you may have, for instance clotting problems or lymphedema (swelling)

TYPES OF CENTRAL VENOUS CATHETERS

1. PORT :

A port is a type of central venous catheter, also called implantable venous access port. It has a small drum made of plastic or metal with a thin tube, called the line, which goes from the drum into a large vein.

·      Ports are permanently placed under the skin of the chest or arm during surgery.

·      The drum has a silicone septum (self-sealing membrane) across the top and special needles are stuck through the skin into the septum to use the port.

·      Single and double ports are available.

·      A port can stay in for many years.

·      It doesn’t require any special care when there’s no needle in it.

·      Once the area around it has healed, you can bathe, shower, or even swim.

·      When it’s not being used, you will need to flush out the port about once a month.

·      Brand names are Port-A-Cath® , Medi-port®

2. PICC LINE

·      A needle is used to put the PICC line into a vein in the arm.

·      The catheter (or line) is threaded through the needle to end in a large vein in the chest near the heart. The needle is then removed.

·      No surgery required to get a PICC line.

·      A PICC line may stay in for many weeks to months.

·      There may be one or more “tails” (lines sticking out of the skin) on the

PICC The PICC and the dressing cannot get wet. It needs to be covered at the time of having a bath. The catheter and the skin around it will need care and regular flushing. Your cancer care team will teach you what to do.

·      Brand names of PICC lines Per-Q-Cath® and Groshong PICC®.

3. TUNNELED CENTRAL VENOUS CATHETERS
                                       

This type of catheter is surgically placed in a large (central) vein in the chest.

·      The catheter is then tunneled under the skin and the openings of the lumens stick out of the skin on the chest.

·      This catheter is good for months to years.

·      The external catheter and the skin around it will need care and regular flushing.

·      Brand names : Hickman®, Groshong®

Potential problems when the catheter is put in

You may have pain/ discomfort where the catheter is put in or where it lies under your skin. The needle or catheter that’s put inside the blood vessel might damage the vessel. This can cause bruising or bleeding at the puncture site, or infection.Sometimes a condition called a collapsed lung (pneumothorax) may develop when a CVC is placed in the chest or neck. This happens when a lung is punctured and air collects in the chest outside the lung.

·      CVC placement guided by ultrasound or fluoroscopy greatly decreases this risk.

·      Normal heart rhythm may be disturbed when the catheter is put in. This is usually only temporary and the normal rhythm returns when the catheter is repositioned. It rarely causes serious problems.

·      In rare cases, the catheter will go into the wrong place, like an artery instead of a vein. If this happens, the catheter will have to be taken out. If there are no other complications, the artery usually heals by itself.

·      Infection may develop at the place in the skin that’s cut or punctured to put in the catheter.

·      Be sure to follow any instructions about caring for the skin around the catheter as it heals.

WHEN TO CONTACT THE ONCOLOGY TEAM IN CASE OF PROBLEMS FACED:

·      Pain, redness, drainage, or warmth at the CVC that’s getting worse.

·      Bleeding where the CVC goes into your body.

·      New trouble breathing or shortness of breath

·      Changes in your heartbeat

·      Dizziness

·      Fever or chills

·      Infection – skin infection can start where the catheter or port goes into the body. More serious bloodstream infections can also happen.

CARE OF THE CENTRAL LINE:

·      Always wash your hands before touching your CVC.

·      Try to keep the dressing dry. This can help prevent infection.

·      When you shower, cover the site with waterproof material (such as plastic wrap taped over it). Be sure you cover both the dressing and the cap(s).

·      The chance of infection can be lessened if you (and anyone else who handles the catheter) wash your hands before using it, change the dressing carefully, check the skin each time the dressing is changed, and use careful sterile technique when using the catheter.

·      You and your career will be taught how to do these things.

·      A hole or break in the catheter may lead to a fluid leak.

·      It’s important to not always clamp the catheter in the same spot, which can weaken that area.

·      Never use too much force when flushing it.

·      If you do notice leaking, clamp the tubing between your body and the leak. Call your cancer care team right away to find out what to do next.

·      The catheter can shift, move, or become kinked or twisted in the vein. If this happens it may need to be repositioned or removed.

·      Any type of catheter may become blocked by clotted blood. You can minimize this risk by carefully flushing the catheter as instructed.

·      Once a catheter becomes blocked, it sometimes can be opened by injecting certain medicines, but it might need to be removed or replaced.

·      Some types of CVCs can move or be pulled out if not taped or sutured to the skin. If the CVC has been pulled, or the tubing sticking out of your skin seems longer, call your cancer care team right away.

·      Certain catheters need to be clamped when not in use, and caps should be screwed on tightly to keep air from getting in.

·      Know how to clamp your catheter and be sure you have an extra clamp at home.

·      Sometimes a blood clot forms around the catheter. This can cause swelling in your arm, shoulder, neck, or head.

·      Contact your cancer care team right away if you notice new swelling. The clot may be treated with blood thinners, but in some cases, the CVC will have to be removed.

·      Tape the tube(s) to your body to help keep from pulling on it. Do not bend or crimp the tubing.

·      Know what you need and keep enough supplies on hand to care for your catheter.

·      Always be sure to have extra dressing change kits in case the dressing gets wet or comes off.

REMOVAL OF CENTRAL LINE/PORT

·      Your doctor or trained oncology nurse will take out your catheter or port when you no longer need it.

·      If you have a PICC line, the doctor or nurse will gently pull the tube until it feels loose. Then they will remove it. This does not usually hurt. You do not normally need anesthesia.

·      If you have port or neck or chest catheter, your doctor or radiologist will make a small cut in the skin. Then they will gently remove the port or catheter. You may need local anesthesia or conscious sedation.

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