BROVIAC® Catheters and HICKMAN® Catheters
What are BROVIAC Catheters and HICKMAN Catheters?
BROVIAC catheters and HICKMAN catheters are similar to a PICC line. They both allow a soft special type of rubber (silicone) IV catheter to be placed in your child without the need for repeated peripheral IV sticks. A BROVIAC catheter, however, is placed directly into a central vein, usually in the neck, upper chest or groin. The catheter proceeds to a position just above the heart. In general, a BROVIAC® catheter is tunneled under the skin and brought out on the chest or thigh away from the site where it enters the vein. Theoretically, this prevents bacteria from gaining access to the central portion of the catheter. Finally, BROVIAC® catheters contain a "cuff" which is buried under the skin. Your child's tissues will grow into this "cuff" and allow the catheter to become more stable, which will reduce the chance of it becoming pulled out.
Tunneled central venous catheter
HICKMAN catheters and BROVIAC catheters are tunneled central venous catheters. The catheter is tunneled under the skin and placed in one of the veins just under the collarbone. The catheter is long enough to reach the large vein that enters the heart. This vein is called the superior vena cava (VEE.na CAVE.uh). The purpose of tunneling the catheter under the skin is to help prevent infection. A small cuff is located around the catheter about one inch inside the place where the tube enters your child's skin. Skin grows into this cuff and keeps the catheter in place. The cuff also acts as a barrier to infection.
Tunneled catheters have 1, 2, or 3 outside openings. These openings are used for many kinds of medical treatments (fluids, medicines, blood samples, etc.). With a catheter, your child does not need to receive a needle each time one of these procedures must be done.
Why does your child need a tunneled catheter?
Some children have IV needs that exceed what a PICC can do. Some may need a catheter for a prolonged period of time - generally greater than 3 months. Others may have a need for extensive blood draws for laboratory tests that may exceed what a PICC can do. Finally, some children may not have large enough peripheral veins to allow for a PICC line. It may be used for chemotherapy, IV medications, IV nutrition, and obtaining blood samples.
If the tunneled catheter is injected (flushed) regularly with an anti-clotting medicine, it does not need to be attached to an IV bag all the time. This allows your child to be mobile. Your child may have the tunneled line only during the hospital stay, or he or she may go home with one.
How is a BROVIAC catheter placed?
Unlike a PICC line, BROVIAC catheters are generally placed in an operating room setting. A surgeon will place such a line. Your child will most likely undergo a general anesthetic (completely asleep) when the BROVIAC catheter is inserted. This is important, as there is more pain and discomfort when this catheter is placed. Additionally, the surgeon will need to use X-rays (fluoroscopy) while placing the line - something which can't be done at the bedside.
In general, a prescription for a pain medication may be given for your child (often Tylenol (acetaminophen) with Codeine elixir or tablets). This prescription pain medication can be used for the first couple of days until the pain subsides. Importantly, do not mix this Tylenol with Codeine with regular Tylenol as this could be harmful to your child).
The doctor makes a small opening in the mid-chest area. Another opening is made where the catheter will enter the vein. A tunnel is formed under the skin between the two openings.
The catheter is passed through this tunnel and then gently threaded into the vein. Your child will get a chest X-ray to make sure the catheter is in the proper location.
Small bandage tapes, called Steri-strips are placed over the openings. The catheter may also have a few stitches to hold it in place.
Are there any possible complications?
The most common long-term complications of central lines are infection, movement that takes the catheter out of the proper position, and damage to the catheter. These can be prevented by daily care.
For more information, visit the American Pediatric Surgical Association website.
How will the staff care for the tunneled catheter while your child is in the hospital?
The hospital staffs goal is to prevent complications, especially infection and movement. While your child is in the hospital, staff will follow these special care procedures:
- Staff will tape the catheter in at least two places outside the dressing, being careful not to pull on the catheter or tubing.
- The dressing will be changed 24 hours after it is inserted; every other day until the site is healed (usually 3-4 weeks); and then twice a week after it is healed. This dressing is sealed around the edges and should be kept clean and dry.
- When the nurse changes the dressing, he or she will check for signs of infection, including redness, swelling, and/or drainage.
- If the catheter is not connected to an IV bag, the nurse will flush it with an anti-clotting medicine (Heparin) at least twice a day to prevent clotting.
Small children and babies with tunneled catheters should be dressed to help keep them from pulling on their catheter or picking at the dressing. Your child should also always have a clamp on the catheter itself and a spare clamp close at hand in case of emergency (see the handout Let's Talk About...how to care for a central venous catheter "emergency").
Note: The cap on the end of the catheter should not be disconnected or opened by anyone except a doctor, nurse, or trained family member.
How do I care for my BROVIAC catheter/HICKMAN catheter at home?
Prior to your use of the BROVIAC catheter a nurse will give you instructions on its use. If your child will use the University of Michigan home infusion group (HomeMed), this training will be done prior to you going home. If you use another infusion company, training will occur at home by a home healthcare nurse, and should be arraigned prior to you taking your child home.
What will it look like?
After the procedure is finished, a sterile dressing will be placed over the area where the BROVIAC catheter is exiting your child's skin. This dressing is an important barrier to prevent infection and you will be taught how to change this dressing. An additional small dressing (steristrip) will be placed on the chest or neck where the catheter is entering the vein; this steristrip will fall off in 7 to 10 days and need not be replaced.
Removal of the BROVIAC catheter
In general, a BROVIAC catheter needs to be removed with a light general anesthesia. This will require a visit to hospital as an outpatient. The procedure itself last only a few moments. A light dressing will be placed over the site where the BROVIAC catheter was. This should stay clean and dry for 2 days and then may get wet in a bath or shower. The dressing will fall off in 7 to 10 days. Because it is a see-through dressing, don't be surprised if you see a few drops of blood on the dressing. Tylenol or Children's Motrin (according to their age and weight) may be used for pain.
For more information, please see BROVIAC Catheter Parent Teaching Handbook.
This information is provided by the University of Michigan Department of Surgery, Section of Pediatric Surgery and
is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care
provider for advice about a specific medical condition.
For additional health information, please contact your
health care provider or our office.
HICKMAN and BROVIAC are registered trademarks of C. R. Bard, Inc. and its related company, BCR, Inc.