A Broviac is a thin, flexible tube that’s surgically placed into a large vein in the chest to deliver medications, nutrition, or fluids directly into the bloodstream over weeks or months. It’s a type of tunneled central venous catheter, meaning part of it runs under the skin before entering the vein, which helps reduce infection risk and keeps it securely in place. Broviacs are most commonly used in children, though adults can receive them too.
How a Broviac Differs From Other Central Lines
The Broviac is a single-lumen catheter, meaning it has one channel for delivering fluids. Its close relative, the Hickman catheter, has two channels (double lumen) and is slightly larger, typically 7 to 9 French in diameter. The Broviac’s smaller, low-profile design makes it a better fit for pediatric patients or anyone who needs just one infusion line at a time.
Both Broviac and Hickman catheters are made from soft silicone with a smooth, rounded tip designed to avoid damaging blood vessels. The silicone is radiopaque, meaning it shows up on X-rays so doctors can confirm the catheter tip is in the right position. Unlike a PICC line, which enters through the arm, a Broviac enters through the chest or neck and is tunneled under the skin, giving it greater stability for long-term use.
Why Doctors Recommend a Broviac
A Broviac is placed when someone needs reliable intravenous access for an extended period. In a study of 146 pediatric placements, the three main reasons were parenteral nutrition (feeding directly into the bloodstream), chemotherapy or bone marrow transplant support, and long-term antibiotic or medication delivery. Parenteral nutrition was the most common indication by a wide margin, accounting for more than half of placements.
The common thread is that these treatments would be impractical or painful through a standard IV. Repeated needle sticks damage smaller veins over time, and many of these medications are too concentrated or caustic for peripheral veins in the hands or arms. A Broviac solves both problems by delivering everything into a large central vein where blood flow quickly dilutes the infusion.
How It’s Placed
A pediatric surgeon places the Broviac in the operating room under general anesthesia. The procedure involves two incisions: one on the chest or neck where the catheter enters a large vein, and a second lower on the chest where the catheter exits the skin. Between these two points, the catheter is threaded (or “tunneled”) under the skin. This tunnel is a key part of the design. By forcing bacteria to travel several inches under the skin before reaching the bloodstream, it creates a natural barrier against infection.
Each Broviac has a small fabric cuff wrapped around the portion that sits under the skin. Over the first few weeks after placement, the body’s own tissue grows into this cuff, anchoring the catheter in place. Until that tissue ingrowth is complete, stitches at the exit site hold the catheter secure. Accidental dislodgement is most common during those initial weeks before the cuff has fully bonded with surrounding tissue.
Keeping the Line Working
A Broviac requires regular flushing to prevent clots from blocking the tube. The standard approach uses normal saline pushed through in small, pulsing bursts rather than one continuous push, since the pulsing action creates turbulence inside the catheter that’s better at clearing residue from the walls. After blood draws or thicker infusions like parenteral nutrition, a larger flush volume (around 20 mL) is recommended.
When the catheter isn’t actively being used, it gets “locked” with a small volume of fluid (typically 1.5 mL for smaller-bore tunneled catheters) to keep the line open between uses. For long-term catheters like a Broviac, this locking step is generally needed about once a week. Clamps on the external tubing should stay closed whenever the line isn’t in use.
Caregivers are trained to perform these flushes at home. The technique becomes routine quickly, though it can feel intimidating at first. Your care team will walk you through each step before discharge and provide supplies.
Possible Complications
The most significant risk with any central line is bloodstream infection. In a comparison study of children with intestinal failure, Broviacs had an infection rate of 4.2 per 1,000 catheter days, higher than PICC lines at 2.6 per 1,000 catheter days. On the other hand, Broviacs were far less likely to break (0.26 vs. 1.56 per 1,000 catheter days for PICCs), reflecting the durability of the tunneled silicone design.
Other complications include occlusion (the line getting blocked, usually by a blood clot) and venous thrombosis, where a clot forms in the vein around the catheter. Broviacs carried a somewhat higher risk of venous thrombosis compared to PICC lines in the same study. Signs of a problem include swelling near the catheter site, fever, redness or drainage at the exit site, or difficulty flushing the line.
When a bloodstream infection is confirmed, removing the catheter is the preferred approach in most cases. Infections caused by certain organisms, including staph aureus and yeast, are particularly difficult to clear with antibiotics alone, making removal strongly recommended in those situations.
Bathing, Swimming, and Daily Life
Water exposure is one of the biggest practical concerns for families. The exit site must stay dry during routine bathing. Most care teams recommend covering the site and external tubing with a waterproof dressing or barrier during showers or baths.
Swimming is a more nuanced question. Many nutrition support programs allow swimming once the exit site has fully healed, typically at least 30 days after placement. The Oley Foundation, a major support organization for people on home parenteral nutrition, notes that there is no documented evidence of swimming causing a catheter-related bloodstream infection. Ocean water and private pools are generally considered safer options, while lakes, ponds, and hot tubs should be avoided due to higher bacterial counts.
If swimming is permitted, a watertight dressing must cover both the exit site and the connection point between the catheter hub and end connector, since that junction is a potential entry point for bacteria. Products like Tegaderm and AquaGuard are commonly used for waterproofing. If the dressing loosens or moisture gets underneath during swimming, the site should be cleaned and redressed immediately afterward. In fact, every swimming session should end with a full dressing change regardless.
When a Broviac Comes Out
A Broviac is removed once the medical condition that required it has resolved, whether that means a course of chemotherapy is complete, the gut has healed enough to resume normal feeding, or the infection requiring long-term antibiotics has cleared. It’s also removed if a serious catheter-related infection can’t be treated while the line stays in place.
Removal is a shorter procedure than placement. Because the fabric cuff has bonded with tissue under the skin, a small incision is needed to free it. The catheter tip is typically sent to the lab for culture, especially if infection was the reason for removal. Recovery from the removal itself is quick, with the small incision healing over the following week or two.