A Broviac and a PICC are both central lines: soft tubes whose tip sits in a large vein near the heart, so medicines or IV nutrition can be given for a long time without repeated needle sticks. They get to that vein by different routes, one threaded up from the arm and one tunneled under the chest skin, and that route shapes nearly everything else about them. Neither line wins on every count, so the choice usually rests on how long the line is needed and which risks matter most for that person.
How Each Line Is Built and Where It Sits
PICC is short for peripherally inserted central catheter. It goes into a vein in the upper arm and is pushed along until its tip reaches a large vein near the heart. The tube comes out of the skin on the arm, usually under a clear dressing. PICCs come in very small sizes, so they can be used even in babies and small children.1PubMed. A comparison of Broviac(®) and peripherally inserted central catheters in children with intestinal failure
A Broviac enters a large vein in the chest or neck, then runs through a tunnel under the skin before coming out, often on the chest. That tunnel is a channel made between the place the line enters the vein and the place it exits the skin, so a Broviac has two separate openings in the body. Because they are a few inches apart, a germ that reaches the exit has to travel along the tunnel before it could get near the bloodstream. A PICC has no tunnel; the tube enters the skin and the vein almost at the same spot.
Sitting inside the tunnel is a small fabric cuff. Over the following weeks, scar tissue grows into it and holds the line in place.2PubMed. New technique for fixation of Broviac catheters You won’t see the cuff, only the tube leaving the skin, and sometimes a small bump or ridge where the cuff lies. Until that tissue grows in, the line can be pulled out by accident fairly easily.3PubMed. New technique for fixation of Broviac catheters So the first few weeks after a Broviac is placed need extra care to avoid tugging on it. Some surgeons put a stitch near the exit at first as temporary support, so it’s worth asking the team whether one was used and when it will come out.
Once healed, the cuff anchors the line from the inside, which is why it resists falling out over months or years. Together with the added distance between skin bacteria and the bloodstream, this is why tunneled lines are chosen for very long use. Hickman lines are a similar tunneled, cuffed design, so you may hear the names used together.
Getting the Line Put In
PICCs are typically placed by a specially trained nurse at the bedside.4Health Line Medical Products. PICC Lines and CVCs One can be put in at a treatment room, a doctor’s office or even at home, using only local numbing medicine.5Journal of Vascular Access Devices. PICC complications in neonates & children Tunneled lines like the Broviac often need a surgical procedure.6Health Line Medical Products. PICC Lines and CVCs7Journal of Vascular Access Devices. PICC complications in neonates & children
For a PICC, the arm is numbed and the line is threaded in, often guided by ultrasound. An X-ray or similar check usually confirms the tip is in the right spot before the line is used, so a short wait before the first use is normal. For a Broviac, children usually have general anesthesia in an operating room, so ask whether sedation is planned and how long you’ll need to fast beforehand.
Adults often need only local numbing, and many stay awake for a PICC. Children are less able to lie still, so they are more likely to need sedation even for a PICC. Parents can ask what will be done to keep the child calm, and whether they can stay until the child is asleep.
Afterward, a PICC arm may feel sore or bruised for a few days. Bleeding that soaks through the dressing, or pain that keeps growing, should be reported to the team. After a Broviac there are usually two small wounds, one where the line enters the vein and one at the exit site. Both need time to heal, and some soreness in the chest or neck is common.
Infection, Clots and Breakage Compared
Doctors compare lines by counting problems per 1,000 days of use, so a line that lasts longer isn’t unfairly penalized. In children on long-term IV nutrition, Broviacs had about 4.2 infections per 1,000 days versus 2.6 for PICCs.8PubMed. A comparison of Broviac and peripherally inserted central catheters in children with intestinal failure In adults on home IV nutrition, PICCs again had fewer infections, 1.05 versus 1.87 per 1,000 days.9PubMed. A comparative study of peripherally-inserted and Broviac catheter complications in home parenteral nutrition patients But another study in children found no real difference in complications between the two once other factors were accounted for.10PubMed. Should you pick the PICC? Prolonged use of peripherally inserted central venous catheters in children with intestinal failure
A line infection means germs have reached the line or the blood through it. They can come from the skin at the exit site, or from hands touching the caps and tubing. That’s why clean handling and hand washing matter for both lines, and why the exit site is watched closely. Treatment is often antibiotics given through the line, and sometimes the line has to be removed and replaced, a cost beyond the illness itself.
Breakage points the other way. In the same children, PICCs broke about six times as often, 1.56 versus 0.26 per 1,000 days.11PubMed. A comparison of Broviac and peripherally inserted central catheters in children with intestinal failure PICCs are thinner and sit in a moving arm. A broken PICC may need replacing, which matters for someone who needs a line for years.
Clots depend on the group. In one group of children, a third had clots in central veins, all after a Broviac, while 8% had arm-vein clots after a PICC.12PubMed. A comparison of Broviac(®) and peripherally inserted central catheters in children with intestinal failure In adults on home nutrition, only PICCs were linked to clots, at 0.4 per 1,000 days.13PubMed. A comparative study of peripherally-inserted and Broviac catheter complications in home parenteral nutrition patients Among critically ill children in hospital, PICCs raised the odds of a clot about fourfold.14PubMed. Identification of a “VTE-rich” population in pediatrics – Critically ill children with central venous catheters
A clot can form on the outside of the tube where it sits in the vein, or inside the tube, blocking it, and a blocked tube may flush with difficulty or not at all. A clot in the vein can swell the arm, neck or face on the side of the line and make the chest veins look more prominent. For someone who will need access for many years, a clot matters because it can damage a vein that may be needed later.
At home, these signs call for action:
- Fever or chills: especially during or after an infusion, these can signal a line infection and need a prompt call.
- Swelling, pain or redness in the arm, neck or face: these can signal a clot.
- Leaking fluid or a crack in the tube: the line may be broken; clamp it above the damage if you’ve been trained to.
- Redness or pus at the exit site: report it the same day, or right away if there is also a fever.
Which Line for Long-Term Home IV Nutrition
IV nutrition delivers all nutrients straight into the blood for people whose gut can’t absorb enough food. The solutions are thick with sugar, protein and fats, and they can irritate small veins. A central line puts the solution into a large vein where blood flow dilutes it quickly, whereas an ordinary IV in a hand or arm vein wouldn’t last long. The infusion often runs many hours a day, sometimes overnight, so the line has to be reliable and comfortable to live with.
European guidelines say home IV nutrition usually uses PICCs, or tunneled lines or implanted ports if it is planned for an extended or unlimited time.15PubMed. ESPEN Guidelines on Parenteral Nutrition: central venous catheters (access, care, diagnosis and therapy of complications) In adults, Broviacs stayed in about 276 days on average versus 74 days for PICCs.16PubMed. A comparative study of peripherally-inserted and Broviac catheter complications in home parenteral nutrition patients A port sits fully under the skin and is reached with a needle, and it is another long-term option alongside tunneled lines.
Duration drives the choice. If IV nutrition is expected for weeks to months, a PICC avoids surgery. If it may last years, a cuffed line avoids repeated replacements. Children with intestinal failure often need years of access, so preserving veins matters. Ask the team how they would switch lines if plans change.
On infection at home, one home-nutrition study found confirmed bloodstream infections at 0.15 per 1,000 days for PICCs, 0.72 for Hickman tunneled lines and 2.02 for ports.17PubMed. Infectious complications in home parenteral nutrition: A long-term study with peripherally inserted central catheters, tunneled catheters, and ports Pooling several studies, PICCs looked lower than tunneled lines, yet the difference wasn’t certain.18PubMed Central. Infectious Complications in Home Parenteral Nutrition: A Systematic Review and Meta-Analysis Comparing Peripherally-Inserted Central Catheters with Other Central Catheters
Daily Care and Living With the Line
Experts give a weak recommendation to flush unused Broviac or Hickman lines daily.19PubMed. Central Venous Catheter Flushing Recommendations: A Systematic Evidence-Based Practice Review There isn’t enough evidence to set heparin doses, and no flushing recommendation exists specifically for PICCs.20PubMed. Central Venous Catheter Flushing Recommendations: A Systematic Evidence-Based Practice Review So follow your own team’s written flushing routine exactly.
The line’s site must stay dry, and waterproof covers help when showering.21Eclipse Regenesis. The Comprehensive Guide to Broviac and PICC Line Care for TPN Patients with SBS Swimming is usually discouraged to avoid germs.22Eclipse Regenesis. The Comprehensive Guide to Broviac and PICC Line Care for TPN Patients with SBS Activities that could pull or damage the line should be avoided.23Eclipse Regenesis. The Comprehensive Guide to Broviac and PICC Line Care for TPN Patients with SBS
Day to day, a PICC in the arm can limit lifting and arm-heavy sports. A Broviac on the chest frees the arms but must be secured under clothing. Young children may tug at a chest line, so taping or a vest helps. Dressing changes follow a set schedule with clean technique.
A dressing that is damp, loose or lifting should be changed rather than left, because moisture helps bacteria grow. Caps and connectors are the points where germs most easily get in, so wash your hands and clean the cap as taught before every use. The team will teach whether dressing changes use clean or sterile technique, and who does them, before you go home.
If a line is pulled partly out, don’t push it back in. Cover the site and call the team, because the tip may no longer be in the right place. If it comes out completely, press firmly on the site and get urgent help; with a Broviac, the site in the chest or neck may bleed more. A line that won’t flush or seems blocked shouldn’t be forced, since forcing fluid through can damage the line or loosen a clot.
For a school-age child, the team can give a letter or plan for school describing the line, activities to avoid and who to call. Sleeping is usually fine once comfortable, but position the tubing so it won’t be pulled or lain on.
Taking the Line Out
A PICC can be removed at the bedside or in clinic.24Stanford Health Care. Central Venous Access Catheters Gentle pulling and pressure on the site is enough to take it out.25PubMed Central. Central venous catheters: Which, when and how There is often little preparation, but ask whether any rules about food or medicine apply, especially for a child.
A cuffed line is different. The cuff has to be cut free from the tissue under sterile conditions, with numbing medicine and possibly sedation.26Stanford Health Care. Central Venous Access Catheters Ask about fasting rules, especially for a child. Broviac removal leaves a small scar near the exit site. If the person takes blood-thinning medicines, tell the team, since they may need to be adjusted beforehand.
A line is removed when it is no longer needed, for example when IV nutrition is no longer required, and the team will often plan that. It may also come out because of a problem, such as an infection that doesn’t clear, a clot or damage to the tube, in which case removal may happen sooner than planned. Sometimes a new line is placed at the same time if treatment needs to continue.