Tunnelled Cuffed Central Venous Access Devices

Key points about tunnelled cuffed central venous access devices

• a tunnelled cuffed central venous access device (CVAD) is a soft, flexible tube that goes into a large vein near the heart
• health professionals use it to give medicines and fluids and to take blood samples during treatment

What is a tunnelled cuffed CVAD?

A tunnelled cuffed central venous access device (CVAD) is a soft, flexible tube. It usually goes into a vein in the neck. It's gently guided through the vein until it sits in a large vein close to the right side of the heart. Part of the tube sits under the skin and part comes out through the chest. 

The loose curved section of tubing outside the body, near the chest, is called the loop. The small capped ends of the tube outside the body are called 'lumens'. There can be 1 or 2 lumens, depending on the device.  

The tube is:

• tunnelled - it passes under the skin before entering the vein
• cuffed – it has a small cuff under the skin that helps hold it in place and reduce infection risk

The CVAD allows easy access to the blood stream to give medicines and fluids and to take blood samples during treatment. 

You can also read the overview page about central venous access devices (CVADs).

Central Venous Access Devices

Why your child might need a tunnelled cuffed CVAD

Your child's healthcare team will use a tunnelled cuffed CVAD if your child needs long-term IV (intravenous) treatment. The device can stay in for months to years if working well.

Putting in the tunnelled cuffed CVAD

Your child will have the procedure under a general anaesthetic in the operating theatre. Your child will be asleep and will feel nothing while the procedure is taking place.

The health professional will make 2 small cuts - one in the chest and one on the neck. The outside of the device usually sits on the upper part of the chest. 

Once the tunnelled cuffed CVAD is in place, health professionals use an x-ray to check the device is in the right position.

After the procedure

The area where the tube went in may feel uncomfortable. This will get better after some time. Your child's healthcare team can give your child some pain relief if needed.

The healthcare team will check for any swelling, bleeding, redness, oozing and pain.  

Caring for your child with their tunnelled cuffed CVAD 

Your healthcare team may show you how to change your child's dressing and care for your child's device.  

Changing dressings

A transparent, waterproof dressing always covers the skin where the tube comes out, and the first few inches of the outside tube. Your healthcare team will change this dressing each week or sooner if it becomes unstuck or dirty. They check the area and give it a good clean with antiseptic solution to prevent infection. They might also use barrier solutions to prevent skin irritation. 

Flushing the catheter

At least once a week, your healthcare team will also check the tunnelled cuffed CVAD to make sure it's working well. They'll flush the catheter lumen with sterile saline and a solution to prevent the catheter from getting blocked. 

Changing the plug

The plug on the end of the tunnelled cuffed CVAD also needs changing each week. Healthcare teams in some centres put a cap on the end of the plug to prevent infection.

Preventing pulling or dragging 

The dressing covers the small loop where the tube exits the skin. This helps to prevent pulling and dragging. If the loop comes out, the healthcare team will change the dressing so they can put the loop back in.

Sports and swimming

Your child needs to avoid swimming and some sports. There is a risk of the catheter being pulled or getting infected during these activities. Talk to your child's healthcare team about the sports your child can safely do with the device in place.  

Showers and baths

Your child can shower but should avoid directly water contact on the dressing. Your child can have shallow baths with the water only at hip level. The bath water should never come above the waist.

Don’t soak the dressing in water as it may become unstuck. If it gets too damp and stays damp, it can cause infection and skin irritation. Keep the end of the tube with the plug out of the water.

Managing water under the dressing

If you know how to do it, change the dressing straight away. Otherwise, tell your child's healthcare team or phone the ward at your local hospital if you are at home.

What to do if there is a problem with the tube

If the tube breaks

• clamp the tube between the break and your child’s body using the clamp from your safety pack
• if you cannot clamp it, fold the tube over and tape it closed
• contact your healthcare team straight away

If the tube is pulled out

• immediately apply pressure to the insertion site on the neck and the exit site in the chest
• contact your healthcare team immediately

If part of the tube (the loop) comes out

• cover the area with a dressing from your safety pack
• do not push anything back in
• contact your healthcare team for a dressing change

When to get medical help 

Medical advice is always available.

Phone the ward if any of the following occur:

• redness
• swelling
• pain
• discharge
• leakage

Removing a tunnelled cuffed CVAD

A tunnelled cuffed CVAD can stay in for months to years. Your child's healthcare team will take it out at the end of treatment, or when your child no longer needs it. Your healthcare team will remove it in the operating theatre under a general anaesthetic. They will also remove it if the area is infected or the device is not functioning properly. 

Your child can usually go home the same day. There will be small scars on their chest and neck. They will not disappear completely but will fade with time.