The major advantage of a CVAD is that it allows easy access to the circulation over a long period of time. This gives added comfort to children and young people who no longer have to undergo repeated venapuncture.

CVADs are used for children and young people who require multiple infusions of fluids including cytotoxic therapy, blood products, drugs or total parental nutrition (TPN). They also provide easy access for routine blood tests.

The correct choice of device for individual children may reduce the risk of catheter related infections. The most appropriate catheter will be selected by the clinician responsible for insertion based on a clinical risk assessment and therapy required.

Hickman line

A Hickman line is the trade name for the most used tunnelled central venous catheter. Other models used include; Groschong, Broviac and Leonard.

N.B. Some Hickman lines have clamps on the line, but the Groschong Line does not and has a patented valve safety system, integral to the line.

A Hickman line is inserted when:

• PICC insertion is not advisable or has failed.
• Venous access is required for a period of between 1 month to 2 years.
• Access is required to administer IV irritants, vesicants, long term antibiotic therapy, TPN, ambulatory chemotherapy, blood products and to obtain blood samples for investigation.
• It is the child or young person’s preference.

PICC (peripherally inserted central catheter) line

The peripherally inserted central catheter (PICC) is an intravenous device. Venous access for PICC placement is usually via the basilic or cephalic vein.

PICC lines are versatile and can be used when:

• Intravenous (IV) therapy is required for up to 4-6 weeks.
• Treatment is given as an in-patient or out patient.
• Administering IV irritants, vesicants, long term antibiotic therapy, TPN, blood products and ambulatory chemotherapy.

Portacath

A Portacath is an implanted device comprised of a portal body, with an integral catheter which is implanted under the skin and designed to provide repeated access to the venous system. The Portacath is made of stainless steel, titanium or plastic and has a hollow reservoir with a latex septum. A side outlet that connects to a silicone or polyurethane catheter which will lie directly in one of the central veins.

The PowerPort device is the first magnetic resonance imaging (MRI) safe port set. It combines reliable venous access with the unique ability for power injected contrast-enhanced computed tomography (CECT) scans (Bard, 2009).

The main advantage of Portacaths over other venous access devices is that they are implanted and therefore, not external to the body. Properly maintained Portacaths can remain in-situ for up to five years or more.

Consequently, there is:

• Less of an impact on the child or young person’s body image as the Portacath is not seen;
• Less risk of infection as the Portacath is not exposed to the external surface;
• No external dressing to the device when it is not being used;
• No risk of accidental pulling/cutting of the device.

Non-tunnelled central venous lines

These are single lumen or multi- lumen lines that are percutaneously inserted into a central vein, usually subclavian, femoral or internal jugular.
These are shorter-term lines and can remain insitu until not needed or a longer-term line is required. These are only used in hospital and will mostly be seen in intensive care and other specialist units.

Non-tunnelled central venous catheters can be used when:

• A child or young person is an inpatient;
• Short-term until not needed or when a longer-term line is inserted;
• When patient has poor venous access;
• Multi-lumen needed, e.g. an Intensive Therapy Unit (ITU). Each lumen should be accessed using an aseptic technique;
• Access is required to administer IV irritants, vesicants, and long-term antibiotic therapy, TPN and blood products;
• Non-tunnelled central venous catheters are not used to deliver chemotherapy because they are a much shorter-term central line.