Central Venous Catheters (CVCs) for the NICU

A central venous catheter (CVC) is a plastic tube that is inserted into a large vein, usually in the arm, leg, belly button (umbilicus), or scalp, to give medicines, fluids, or nutrition. A CVC is used when IV therapy is needed for a long time or when the small veins in the body can no longer be used for IV therapy.

Type of CVCs in the NICU

  • Umbilical venous catheters (UVCs)
  • Peripherally inserted central catheter (PICC)
  • Intervention radiologist placed PICC (IR PICC and CVL)

Benefits and Uses

A CVC can be used for many things. Having a CVC rather than a regular IV has many benefits, including:

  • Less needle sticks (This does not mean that they will never have to be stuck again.)
  • Secure and stays in the vein for a long time
  • Gives medicine
  • Gives parenteral (IV) nutrition or IV fluids
  • Used to draw blood samples for testing (UVCs and IR PICCs only). This is not always possible. Your child may still need to be stuck for blood draws.

Inserting the CVC

  • UVCs are inserted by specially-trained health care providers at your baby’s bedside. They are inserted through the belly button (umbilicus) into a vein. An X-ray will check that the UVC is in the right spot. These lines are usually only used for the first 7 to 10 days of life.
  • If your baby needs IV access for nutrition, then they will need a peripherally inserted central catheter (PICC). These can also be placed at your baby’s bedside and will be checked with an X-ray. Your baby will not need to be moved to get or check the UVC
    or PICC.
  • Your baby may go to interventional radiology to have the CVC placed if it can’t be placed at the bedside. Once it is in place, IV nutrition, fluids, and medicines can be given.

Caring for the CVC

  • The CVC will either be stitched to the skin or held in place by a special bandage or device. The stitches or securing device will stay as long as the catheter is in place.
  • For 1 or 2 days after the CVC is inserted, the skin may be tender where it comes out of the skin (exit site). This will go away within a few days. Anyone caring for the CVC must wash their hands and wear gloves before handling it.
  • A sterile bandage (dressing) is placed over the wings and exit site to keep them clean and dry.
  • The end of the catheter will be attached to IV tubing that runs through a pump to give your child fluid, medicines, or nutrition.
  • Do not let the IV tubing or catheter get pulled. It may hurt your child or break the catheter. Tell the nurse if any part of the catheter comes out from under the tape so it can be secured.
  • Ask for help when you want to get your baby in and out of bed. This will help decrease the chance of pulling the CVC and IV tubing.
  • The dressing on an IR PICC will be changed every 7 days. It may be changed sooner if it gets wet, dirty, or loose. The sterile dressing on the NICU-placed PICCs are changed as needed when loose, wet, dirty, or non-occlusive.
  • The cap (or connector) will be changed depending on the kinds of medicines or fluids your child gets.

Warning

  • The infusion tubing can get wrapped around a child’s neck. This can lead to choking (strangulation) or death. 
  • DO NOT leave the infusion tubing where infants or children can get tangled up in it.
  • Talk to your child's health care provider or doctor:
    • If your child has been tangled in their tubing before.
    • To learn the steps to take to help make sure the tubing does not get wrapped around your child’s neck, such as keeping the tubing away from the child as much as possible.
    • Any other concerns you may have about the risk of strangulation from infusion tubing.
  • If your child is injured by the infusion tubing, please report the event to the FDA. Your report can provide information that helps improve patient safety. The website to make a report is available here.

Skin Treatment

Your child has a higher risk of infection because of their CVC. Good skin care can help prevent infection. While your child has a CVC in the hospital, they will either get a sterile water bath, Sage cleansing cloth bath, or Chlorhexidine gluconate (CHG) treatment one time every 24 hours.

  • Your child will NOT get a CHG treatment if they are younger than 2 months of age, have a CHG allergy, their skin is not intact, or they have other reasons why they cannot.
  • You may help give your child the skin care treatment by following these steps:
  1. You will get 6 cloths to use. Use 1 cloth for each arm and leg (4 total). Use 1 for the front and back of the torso (2 total). Wipe with a back-and-forth motion for about 20 seconds on each separate area. Do not reuse any cloths on any areas.
  2. Do not use CHG cloths on the face, ears, eyes, nose, mouth, or private areas (genitalia). You may use Comfort Bath® cloths to wash these areas.
  3. Do not wipe the cleansing cloths over the CVC dressing. If the dressing gets wet or becomes loose, tell the nurse.
  4. Let the skin air-dry. Do not rinse the area with water. Tell the doctor or health care provider if redness, rash, irritation, or an allergic reaction happens on the skin.
  5. Do not use lotions, creams, deodorants, or powders on any of the days CHG cloths are used.
  6. Throw the CHG cloths away in the trash. Do not flush them down the toilet.

Possible Problems

Some problems can occur with a CVC. These may include:

  • Infection at the exit site or in the blood. Some infections can be treated with antibiotics without removing the catheter. In other cases, the catheter must be removed.
  • Check the site for redness, swelling, pain, or yellow or green drainage.
  • Broken catheter outside the body. A hole or tear may develop in the catheter, or there may be a break at the catheter hub. If this happens, cover the CVC with a sterile dressing and tell the nurse or health care provider right away.
  • Blood clots in the catheter or in the vein. Most catheters do not need to be removed if the clot can be treated (dissolved).
  • The catheter moves out of the place in the vein. The catheter may need to be repositioned or replaced.

Removing the PICC Line

The CVC will be removed when IV therapy is finished or if there is a problem with the CVC. This is done by removing the dressing and cleaning the exit site. Then, the stitches or the securing device are removed. The CVC should, then, gently slide out. It does not hurt.

If you have any questions, be sure to ask your child’s doctor or health care provider.

Helping Hands™ Patient Education Materials

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