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. The tube can also be called a 'line' or 'catheter'. 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. There is a short length of the tube outside the body, on the chest.
Some tubes have 1 end. Others have 2 or more ends. The ends are called 'lumens'.
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 bloodstream 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).
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
Changing dressings
A transparent, waterproof dressing always covers the skin where the tube comes out, and the first few inches of the outside tube. This helps to prevent pulling and dragging on the 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.
Checking the device
At least once a week, your healthcare team will check the device to make sure it's working well. They'll flush it with sterile saline and a solution to prevent the tube from getting blocked.
Sports and swimming
Your child needs to avoid swimming and some sports. There is a risk of the tube 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 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.
Checking the device and dressing each day
- redness
- oozing
- the dressing coming off
- the tube coming out
- water under the dressing
If the dressing starts to lift or come off, contact your homecare nurse for a dressing change.
Taking your child's temperature
Take your child's temperature each day. If it is above 38 degrees Celsius, tell your healthcare team immediately.
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 put pressure on the insertion site on the neck and the exit site in the chest
- contact your healthcare team immediately
If part of the tube 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
Contact your healthcare team if any of the following happen:
- 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.
Acknowledgements
All the pages in the childhood cancer section of this website have been written by health professionals who work in the field of paediatric oncology. They have been reviewed by the members of the National Child Cancer Network (NZ). Medical information is authorised by the clinical leader of the National Child Cancer Network.