Key points about tunnelled uncuffed central venous access devices
- a tunnelled uncuffed 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 uncuffed CVAD?
A tunnelled uncuffed 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
- uncuffed – it does not have a cuff under the skin
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 uncuffed CVAD
A tunnelled uncuffed CVC is useful for smaller pēpi (babies) if they need weeks of IV (intravenous) treatment. The device can stay in for months if it's working well.
Putting in the tunnelled uncuffed 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 on the neck and one on the chest.
Once the tunnelled uncuffed CVAD is in place, health professionals use an x-ray to check the device is in the right position.
Your healthcare team will cover the tube on the outside of your child's body with a see-through dressing.
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 uncuffed CVAD
Keeping the tube dry
Keep the tube dry. If your child has a bath, make sure the water level is below the tube.
Avoid pulling the tube
Take care when dressing your child so you don't pull the tube out.
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.
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 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 is pulled out
- immediately apply pressure to the insertion site
- contact your healthcare team straight away
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 the fold together to work as the clamp
- contact your healthcare team straight away
If the dressing starts to lift or come off
- cover it with a dressing from the safety pack
- contact your healthcare team for a dressing change
- the safety pack should include sterile gauze, a clamp, a dressing and any extra supplies your child needs
When to get medical help
Contact your healthcare team if any of the following happen:
- redness
- swelling
- pain
- discharge
- leakage
Removing a tunnelled uncuffed CVAD
A tunnelled uncuffed CVAD can stay in for weeks to months. Your child's healthcare team will take it out at the end of treatment, or when your child no longer needs it. Removal is usually a simple procedure. Your nurse will usually remove the device. Your child will have a dressing for 1 to 2 days until the skin heals.
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.