BROVIAC® catheters* for central venous access

(Version 1.0  1/19/2000 - 02/14/2008)

A BROVIAC® catheter is a 3Fr single lumen silastic catheter which is surgically inserted with its tip in the lower superior vena cava at the entrance to the right atrium. The catheter is pulled through a subcutaneous tunnel so that it exits from the skin remote from the venous access site. At the exit site, the catheter is placed between silastic sheeting with the sheeting being sutured to the skin. A BROVIAC® catheter is placed in high-risk infants to provide for long-term venous access for the purpose of continuous fluid administration/ parenteral nutrition and administration of medications. Usually these patients are surgical patients or infants in whom percutaneous central venous access has failed.

 

BROVIAC® Catheter Insertion

BROVIAC® catheters may be placed when the patient is in the OR for a simultaneous procedure or at the bedside in the NICU. The surgeon should notify the patient’s nurse to prepare the infant for the procedure and set up the tray. The tray will be opened and prepared in a restricted area and under sterile conditions using cap, mask, and gloves. The X-ray plate should be placed under the infant before the procedure is started. The insertion should be performed under strict sterile conditions using gown, mask, gloves and a sterile field. Traffic should be restricted around the infant’s bedside during the procedure. A nurse should be in attendance during catheter insertion. X-ray should be notified promptly when the line is inserted. Catheter placement must be documented by a chest x-ray prior to infusion of any hypertonic solution (> D12.5W.)

DRESSING CHANGES

A dressing is applied to the insertion site after catheter placement. The transparent dressing should be changed every 5 days. The 2x2 gauze should be changed every 48 hours. The catheter and/or IV lines should be secured to the patient to prevent dangling/accidental dislodgement.

IV INFUSIONS AND TUBING CHANGES

Double or multiple lumen connectors are usually on all central lines for TPN/IL infusion. Stopcocks should not be used on BROVIAC® catheters.  All IV infusions through the catheter must be administered by an infusion pump.

Clear IV fluids should be changed every 72 hours. TPN fluids and Intralipid should be changed every 24 hours. All tubing should be changed every 72 hours. Prior to March 2001, IL tubing had been changed every 24 hours; close surveillance of nosocomial infection rates over the subsequent 6 months should reveal whether the new practice of changing IL tubing q 72 hours is safe as well as practical. The injection site cap should be labeled with date of application and changed every 5 days.

Strict aseptic technique using sterile gloves and a sterile field should be used when breaking the closed system. IV tubing junctions and injection sites should be cleaned with betadine and allowed to dry 30 seconds before entering the line. Once the breakage is completed and the system is once again closed, the betadine residue should be removed with alcohol.

A normal saline flush should be used at a proximal site to the catheter when changing IV tubing. The flush can be used to prevent blood from backing up into the system when the IV fluids are being changed out and reinserted in the infusion pumps.  A bull dog clamp should be accessible at all times for occluding purposes. Use gauze between the clamp and the catheter.

DRAWING BLOOD FROM A BROVIAC® Catheter

Sick newborns are at significant risk for developing line sepsis. Risk increases with the duration the central line is in place and with the frequency/sterility of line breaks. Therefore, the line is not to be entered routinely for purposes of blood sampling or transfusing blood products. If it is deemed necessary to obtain a blood sample from the line, it should be done at the time of daily IV fluid tubing changes (with the exception of blood cultures.) When drawing blood samples from the BROVIAC® catheter, draw back 1.5mL of blood to clear the line. This blood should be discarded, not re-infused.

MEDICATION ADMINISTRATION

Medications may be administered through the BROVIAC® catheter when IV access is a problem or continuous medication administration is needed. Medications should be delivered using an injectable access port. The line should not be routinely disconnected for medication administration.

HEPARIN-LOCKS

If a BROVIAC® catheter is heparin locked, it should be flushed with heparinized saline solution every 24 hours. The standard concentration is 0.2mL heparin (1000 Unit/mL concentration) per 10mL non-bacteriostatic saline (final concentration of heparin 20 Unit/mL.)   Instill approximately 2.5mL of heparinized solution into the catheter. Withdraw the needle during the last 0.5mL of the flush to maintain positive pressure (to prevent blood from backing up into the line.)

TROUBLESHOOTING

The baby’s bedside nurse should monitor the BROVIAC® catheter site for any drainage, redness, or edema, and the condition of the dressing. If blood backs up or air is noted in the tubing or the injection cap site:

    1. A sterile field must be created and gloves used to break the line. A sterile saline solution should be used as flush.

    2. Changing connector tubing or the injection site cap may be necessary.

If resistance is met in flushing the line, the catheter is leaking, or any anomalies at the insertion site are noted, the nurse should notify a NICU physician or the pediatric surgery team immediately.

LINE OCCLUSIONS

If a BROVIAC® catheter is occluded, assess the continued need for the catheter, other options for vascular access, length of therapy remaining, and the condition of the baby’s veins.  If considering a clearing agent, weigh the risks and benefits of the procedure.

For a blood clot, a physician may order and administer TPA (1mg/ml).  Instill 1-3 mL of TPA into the catheter and allow 30-60 minutes of dwell time before attempting to draw and flush the catheter.

For a lipid occlusion, 70% ethyl alcohol may be tried. Instill 1-3mL (maximum of 0.55 mL/kg) and allow 1-2 hours of dwell time.

For an alkaline drug precipitate (for ex. phenytoin) NaHCO3 may be administered. Use the 1 mEq/ml (full strength) solution; instill 1-3 mL and allow a 60 minute dwell time.

If unable to restore patency, the line must be removed.

* BROVIAC® is a registered trademark of C.R.Bard, Inc. and its related company, BCR, Inc.

        Archived Versions: None