What is a CVL?
A central venous line (CVL) is a special intravenous (IV) line. A CVL is a long, soft, thin, flexible tube that is inserted into a large vein. You might also hear a CVL called a central line or a central venous catheter.
Why is a femoral CVL inserted?
A femoral CVL is used in children who need IV therapy for specific needs. IV therapy can include medications, chemotherapy, hemodialysis, apheresis and IV fluids.
Regular IV lines are usually inserted into a vein in the hand, arm or foot. A child who needs IV therapy for specific needs may require an IV inserted into larger veins such as the femoral vein.
If your child has a femoral CVL inserted to receive IV therapy, total parental nutrition (TPN), dialysis or for stem cell collection, it can also be used to take blood samples.
Where can CVLs be inserted?
CVLs are inserted at femoral, subclavian and internal jugular sites.
The femoral venous site is used for central venous access in infants and children:
- for placement of a temporary hemodialysis or apheresis catheter
- for diagnostic catheterization
- for interventional procedures
- when the catheters do not need to be in place longer than seven to 14 days
How are femoral CVL’s inserted?
The femoral CVL is inserted using image guidance by an interventional radiologist, but it can also be inserted by an anaesthetist or a surgeon in the operating room, or by an intensivist in the intensive care unit.
For CVLs that are inserted by an interventional radiologist, the initial point of entry is below the inguinal (groin) ligament. The needle is inserted into the femoral vein with the assistance of ultrasound and a special X-ray called fluoroscopy. A guide wire is then put into the vein, and the needle is removed. The femoral catheter is then threaded over the wire, and the guide wire is removed. The catheter is finally stitched and/or secured in position and covered with a clear bandage.
If the femoral CVL is inserted without the assistance of fluoroscopy, an abdominal X-ray may be done to check the position of the CVL.
Risks of a CVL insertion
A CVL insertion is usually a low-risk procedure. The risk may increase depending on your child’s condition, age and health.
The risks of any CVL insertion can include:
- failure to find an open vein that will accept the CVL
- bleeding or bruising
- pain or discomfort
- infection
- clotting
- air in the lungs or veins
- irregular heart rhythm
- breakage of the catheter
- movement of the catheter
- X-ray exposure
- vein perforation
- nerve or artery damage
Preparing for a CVL insertion
If your child is already in the hospital, you will meet a nurse from the Vascular Access Service who will explain the procedure and answer your questions. If your child is an outpatient, the health-care team looking after your child will explain the procedure to you.
Giving consent before the procedure
Before the procedure, the interventional radiologist or nurse practitioner will go over how and why the procedure is done, as well as the potential benefits and risks. They will also discuss what will be done to reduce these risks and will help you weigh any benefits against them. It is important that you understand all of these potential risks and benefits of the CVL insertion and that all your questions are answered. If you agree to the procedure, you can give consent for treatment by signing the consent form. A parent or legal guardian must sign the consent form for young children. The procedure will not be done unless you give your consent.
How to prepare your child for the procedure
Before any treatment, it is important to talk to your child about what will happen. When talking to your child, use words they can understand. Let your child know that medicines will be given to them to make them feel comfortable during the procedure.
Children feel less anxious and scared when they know what to expect. Children also feel less worried when they see their parents are calm and supportive.
Food, drink, and medicines before the procedure
- Your child’s stomach must be empty prior and during sedation or general anaesthetic.
- If your child has special needs during fasting, talk to your doctor to make a plan.
- Your child can take their regular morning medicine with a sip of water two hours before the procedure.
Medicines such as acetylsalicylic acid (ASA), naproxen or ibuprofen, warfarin, or enoxaparin may increase the risk of bleeding. Do not give these to your child before the procedure unless they have been cleared first by your child’s doctor and the interventional radiologist.
On the day of the femoral CVL insertion
Your child will have medicine for pain
It is important that your child is as comfortable as possible for the procedure. Your child will receive local anaesthetic for the femoral CVL insertion, so they will not feel anything during the procedure. Your child may also receive sedation or a general anaesthetic for the femoral CVL insertion.
During the procedure, you will be asked to wait in the waiting area.
After the femoral CVL insertion
Once the femoral CVL insertion is complete, your child will be moved to the recovery area. The interventional radiologist will come and talk to you about the details of the procedure. If it was done under sedation or general anaesthesia, as soon as your child starts to wake up, a nurse will come and get you.
After having a CVL inserted into the femoral vein, your child will have a clear bandage over the femoral line exit site. Your child should be on bedrest with bathroom privileges until the femoral line is removed.
The femoral CVL can be used right away for your child's medication or fluids. Your child should not feel any pain when the femoral CVL is being used.
Pain relief after the procedure
After the procedure, some children may feel mild pain or discomfort in the groin area for the first day or two. If this happens, ask your nurse or doctor if your child can have something to relieve the pain.
Once your child has fully healed, they should not have any pain or discomfort from the CVL.
Femoral CVL complications
Complications may occur with your child’s femoral CVL. The line may break or leak, the cap may fall off, the dressing can come loose or the CVL can fall out. Broken CVLs will need to be removed and replaced.
Other possible complications include clotting of the CVL, blood in the catheter or cap, and infection. Your child’s health-care team will monitor for these while your child is in the hospital.
Caring for your child with a femoral CVL
There must always be a bandage over the femoral CVL exit site on the leg. This bandage keeps the CVL clean and secure. The end of the catheter tube, called the hub, will be closed with a cap.
A nurse will care for your child’s femoral CVL.
To prevent the CVL from becoming blocked, it will always have one of the following:
- An infusion, where fluids are being pushed into the CVL through a pump.
- A heparin lock. Heparin is a medication that helps prevent the CVL from becoming blocked when there is no fluid infusing into it. New heparin will be flushed into the CVL after each use. If the CVL is not being used each day, the heparin flush will be done every 24 hours.
It is important to always keep the CVL dry. If the CVL gets wet, it can become infected. Your nurse will cover the CVL to keep it dry when your child bathes. If the bandage gets wet, it should be changed right away.
Protecting the femoral CVL
Although the femoral CVL is quite secure, it is not attached to anything inside your child's body; so if it is pulled, it can come out. It is very important to make sure the femoral CVL is always taped in place. It is also recommended to tape the tube(s) of the CVL to your child’s leg. Keeping the CVL taped to the body will also prevent it from twisting or kinking. This is important to prevent it from becoming damaged or broken.
Your child should be on bedrest with bathroom privileges until the femoral line is removed.
How long can the femoral CVL stay in?
A femoral CVL generally stays in for seven to 14 days, as long as it remains problem-free and working well.
Removing the femoral CVL
Once your child's health-care team is confident that the femoral CVL is no longer needed, they will remove the femoral CVL. If your child needs long-term therapy, the femoral CVL will have to be exchanged for a permanent internal jugular vein CVL under general anaesthesia.
When to seek medical assistance
Contact your doctor or go to the nearest Emergency Department right away if your child has any of the following:
- A fever higher than 38°C (100.4°F), or over the normal range provided by your doctors or nurses
- Pain requiring acetaminophen after 48 hours
- Bleeding that does not stop with pressure
- Leakage or drainage at the former CVL site
- Difficulty breathing
- A funny feeling in their heart
- Noticeable swelling in the groin
Each child’s situation is different, so you should ask your doctor if there are any specific instructions for your child.
At SickKids
At SickKids, the interventional radiologists work in the Department of Diagnostic Imaging – Division of Image Guided Therapy (IGT). You can call and speak to the Vascular Access Service resource nurse at (416) 813-6986 during working hours, or leave a message with the Vascular Access Team. If you have concerns and it is after working hours, please call The Hospital for Sick Children switchboard at 416-813-7500 and ask them to page your child’s doctor on call, or go to the nearest Emergency Department.
For more information on fasting, see “Eating and drinking before surgery.”
For more information on preparing your child for their procedure, see “Coming for surgery.”