When a child or young adult is first diagnosed with cancer, they will typically need to have a central line inserted. These are known as Central Venous Access Devices (CVADs). They remain in the vein throughout the entire course of treatment and help to provide safe and efficient access for blood tests and treatments such as chemotherapy, without the need for constant needle pinpricks and cannulas.
Different names are given to CVADs depending on where they are located in the body.
This includes Hickman central lines, PICC (peripherally inserted central catheter) lines and port-a-caths (vascular ports). The device that is inserted will depend on the child’s age and size, and the primary purpose of the device.
Central lines are also commonly known as Hickman lines and Broviac lines. A central line is a soft tube that is inserted through the chest into a large vein during a small procedure under general anaesthetic. A central line provides long-term access to the blood stream and includes multiple tubes, which allows more than one medication to be delivered at once. This helps make treatment faster and less upsetting for children and young adults. Your care team will support you to care for the central line, which may include weekly dressing changes and line flushing.
You may also hear of vascular ports referred to as implantable ports or port-a-caths. A vascular port is a small device that is placed under the skin in the chest which is connected to a large vein using a catheter. It is fitted during a procedure under general anaesthetic and helps provide easy access to the blood stream. As the device sits under the skin, a needle is inserted through the skin into the chamber of the vascular port to deliver treatment. This needle can remain in the port for up to a week at a time, which helps reduce the need for constant needles.
Other benefits compared to central lines include:
PICC lines are typically used for short courses of treatment to provide direct access to the blood stream or until a vascular port or central line can be fitted for long term treatment. A PICC line is a soft tube that is inserted into a vein in the arm and threaded towards the heart. It is typically inserted under general anaesthetic (although in some instances local anaesthetic may be used), and is held down using a dressing.
During cancer treatment, some children and young adults are unable to maintain good nutrition and a healthy weight despite a balanced diet. In these cases, or when they are too unwell to eat, your care team may suggest a nasogastric tube or a gastronomy feeding device to provide additional nutrition. These deliver nutrients and oral medications through a tube directly into the stomach.
A nasogastric tube is a soft tube that is inserted through the nostril and into the stomach via the oesophagus. This is typically a quick and easy process, although can be uncomfortable during insertion. The tube is held in place in the nostril using a piece of tape and can be used to deliver feed and oral medications into the stomach, even while asleep. Your care team will discuss how to take care of the tube at home including instructions on what to do if the tube comes out. The tube will also need medical attention to change every few weeks.
Gastronomy devices, also known as percutaneous endoscopic gastrostomy (PEG) tubes, are often used as a safer, discreet and more comfortable option compared to a nasogastric tube if tube feeding is needed over a longer period of time. They involve a tube being inserted directly into the stomach, rather than through the nostril and oesophagus, which is preferable for children and young adults receiving treatment for head and neck cancers.
If you have any questions around central access devices or feeding tubes, please don’t hesitate to ask your care team at any time. We are here to support you every step of the way.