For many medical treatments, including extended courses of antibiotics, chemotherapy, or nutritional support, reliable and long-term access to the bloodstream is necessary. This is accomplished using a central venous catheter, a thin tube placed in a large vein. Two common types of these devices are the Broviac catheter and the Peripherally Inserted Central Catheter, or PICC line. While both serve a similar function, they have distinct characteristics that influence which one is chosen for a patient.
What Are Broviac and PICC Lines?
A Broviac is a type of tunneled central venous catheter. It is inserted into a large vein in the chest, such as the subclavian or internal jugular vein, and its tip is advanced until it rests in the superior vena cava, the large vessel that carries blood directly to the heart. The other end of the catheter is then “tunneled” under the skin of the chest to emerge from a small, separate exit site on the chest wall.
A key component of the Broviac catheter is a small ring called a Dacron cuff, which is positioned within the subcutaneous tunnel. This cuff serves two main purposes. Over time, the body’s tissues grow into the cuff material, which helps to anchor the catheter securely in place. The cuff also acts as a barrier, making it more difficult for bacteria from the skin surface to cause an infection in the bloodstream.
In contrast, a PICC is a Peripherally Inserted Central Catheter. As its name implies, this catheter is inserted into a peripheral vein in the upper arm, such as the basilic, brachial, or cephalic vein. From this entry point, the long, flexible tube is carefully threaded through the venous system until its tip also resides in the superior vena cava, near the heart.
Even though its insertion point is in the arm, a PICC functions as a central line because its tip delivers medications or fluids directly into the body’s central circulation. This allows for the administration of substances that might be irritating to smaller, peripheral veins. Unlike a Broviac, a PICC line is not tunneled under the skin and does not have an integrated cuff for anchoring. It is instead held in place at the arm’s insertion site with a sterile dressing and a securement device.
The Placement and Removal Process
Placing a Broviac catheter is a minor surgical procedure. It is performed in an operating room or an interventional radiology suite and often requires moderate sedation or general anesthesia. The physician makes a small incision to access the central vein and a second small incision for the exit site on the chest, creating the subcutaneous tunnel between them for the catheter.
PICC line placement is a less invasive procedure that can often be performed without full sedation. It is frequently done by a specially trained nurse or radiologist at the patient’s bedside, in a clinic, or a radiology department. Ultrasound guidance is used to identify a suitable vein in the arm and guide the needle insertion. A local anesthetic is used to numb the skin at the insertion site.
A PICC line can usually be removed quickly and with relative ease by a trained nurse. The procedure involves gently withdrawing the catheter from the arm after removing the dressing and securement device.
Removing a Broviac catheter can be slightly more involved. Because the Dacron cuff is designed to have tissue grow into it, it can become firmly embedded. While some Broviacs can be removed with steady traction, others may require a small incision at the exit site to free it from the surrounding tissue.
Daily Management and Lifestyle Considerations
Living with either a Broviac or a PICC line requires consistent care routines. Both lines must be flushed regularly with saline and sometimes a heparin solution to prevent blood from clotting inside the catheter. The sterile dressing covering the exit site must also be changed on a routine schedule, usually once a week or if it becomes damp or soiled.
Keeping the exit site dry is a primary concern, meaning that showering requires a waterproof cover to be placed securely over the dressing. Submerging the line in water, such as in a bath or swimming pool, is prohibited for both Broviac and PICC lines due to the high risk of causing a serious infection.
The location of the catheter can influence daily activities. A PICC line, being situated in the arm, can sometimes limit function on that side. Patients are often advised to avoid heavy lifting or repetitive motions with the affected arm, as these activities could damage or dislodge the catheter. A Broviac, exiting on the chest, generally allows for more freedom of arm movement.
Typical Use and Duration
The decision to use a PICC line versus a Broviac catheter is often guided by the expected duration of therapy. PICC lines are intended for intermediate-term use, from a few weeks up to several months. They are a common choice for treatments like a six-week course of intravenous antibiotics or several cycles of chemotherapy.
Broviac catheters are selected for long-term or indefinite treatment plans. These devices are designed to remain in place for many months or even years. They are frequently used for patients who require intensive, long-duration treatments, such as children undergoing bone marrow transplants or individuals with chronic conditions who depend on total parenteral nutrition (TPN).
The secure, tunneled design and the anchoring cuff make the Broviac a more durable option for prolonged use. This stability and longevity makes it a preferred choice in many pediatric cases and for adults with chronic illnesses.
Associated Risks and Complications
Both Broviac and PICC lines carry risks, primarily related to infection, blood clots, and mechanical problems. A major concern is a central line-associated bloodstream infection (CLABSI). This occurs when bacteria enter the bloodstream via the catheter, which can lead to a serious systemic infection.
The formation of blood clots, or thrombosis, is another potential complication. A clot can form inside the catheter, causing a blockage, or in the vein around the catheter. PICC lines are particularly associated with a risk of deep vein thrombosis (DVT) in the arm, as the catheter occupies space within the smaller arm vein, which can impede blood flow.
Mechanical issues can also arise with both types of catheters. Catheters can become dislodged or migrate from their ideal position; this is a greater concern with PICCs if the external securement device fails. Blockages, known as occlusions, can prevent the line from being used and may be caused by clots or medication precipitate. The external portion of either line can also be damaged, cracked, or cut, which may require a repair kit or complete replacement of the catheter.