What is a central line or access port?
A central line is a soft tube, called a catheter, that pediatric surgeons place in a vein. We place access lines in children who receive medication, fluids and nutrients that must be delivered directly into the bloodstream. At Children’s Hospital Colorado, we use central lines to care for infants and children because they have small veins that are often difficult and painful to enter Having a central line or access port helps to avoid multiple needle sticks.
Pediatric surgeons place over 400 pediatric central lines and access ports every year
Every member of your child’s care team is trained and experienced in caring for kids. That means from our pediatric surgeons and nurses to our pediatric anesthesiologists we have the knowledge and know-how to provide excellent treatment for kids. We make sure that you and your child understand what is happening, what to expect and what your choices are. We will explain everything in a manner that is easy to understand and age appropriate.
Why does my child need a central line or access port?
There is a wide variety of reasons why a child may need or benefit from a central line, including:
- Chemotherapy for cancer treatment.
- Intravenous nutrition, when a child can’t absorb enough nutrition through the normal digestive process.
- Long-term intravenous antibiotics.
- Blood diseases, like hemophilia where a child’s blood doesn’t clot normally and they need medicine to help prevent bleeding.
- Kidney failure requiring hemodialysis, a procedure that cleans a child’s blood. These catheters are larger and require special attention.
What can patients and families expect from a central line placement?
Pediatric surgeons place central lines and access ports while your child is under anesthesia. Our pediatric anesthesiologists keep your child in a painless, sleep-like state during the procedure.
To perform the operation, the surgeon uses an X-ray, a needle and a catheter that is small in size and designed specifically for a child. During the operation, your child’s surgeon locates the large vein that flows into the heart and makes a needle stick or an incision. Most of the time, the catheter or port is placed in the chest or neck, but can also be done on your child’s arm.
Next, the catheter is threaded into the vein and the tip ends just above the heart. One or two stitches keep the catheter in place. Depending on the type of access line your child receives, they may or may not have a tube exiting their body.
The central line, or access port, is immediately ready to use and within a few days your child is pain-free. Before your family leaves the hospital, your pediatric care team will teach you how to care for your child’s central line. Children can be discharged from the hospital and go home the same day unless other treatments are still needed.
Types of vascular access devices
Pediatric surgeons use several factors to decide which type of vascular access device to use for your child, including:
- The length of time the access line will be used.
- How often the access line will be used.
- The patient’s venous anatomy.
Pediatric surgeons at Children’s Colorado use three main types of devices. Your child’s doctor will decide which one is best.
- Children usually receive external tunneled catheters when the access line is used for a long period of time multiple times per week.
This type of catheter is usually placed in the neck or upper chest to access the large veins above the heart (superior vena cava). They have a separate exit site.
They have multiple names, including Broviac, Hickman, Groshong, Permacath and Quinton.
- Pediatric surgeons use implantable ports when a child needs the access line for a long period of time, but use it less frequently, like once a week.
Implantable ports have two parts: the port and the catheter. The port is placed under the skin and has a silicon top that can be accessed with a special needle. The attached catheter is also under the skin and allows fluid to flow from the port into a central vein.
Placement under the skin allows normal bathing, swimming, etc.
- Peripherally inserted central catheters (PICC) are used when a child will need the access line for a shorter period of time and use it multiple times per day.
Peripherally inserted central catheters are smaller, longer lines that are inserted into a peripheral vein, usually in the arm, and are carefully threaded into the central veins near the heart.
Caring for an access port or central line