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Tunnelled central line

Published by Bupa's health information team, July 2008.

This factsheet is for people who are planning to have a tunnelled central line fitted, or who would like information about it.

Tunnelled central lines are sometimes called central venous catheters, long lines, Hickman® or Groshong® lines. The central line is placed under the skin in your chest into a vein close to your heart. It is used to give medical treatment without the need for repeated injections.

Your care will be adapted to meet your individual needs and may differ from what is described here. So it's important that you follow your doctor's advice.

Animation - How a tunnelled central line is placed
About tunnelled central lines
What are the alternatives?
Preparing for your procedure
About the procedure
What to expect afterwards
Going home with a central line
What are the risks?
Further information
Questions and answers
Related topics
Sources

How a tunnelled central line is placed

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About tunnelled central lines

The central line is a hollow tube with an opening at each end. One end sits outside your body and the other end is placed in a vein in your chest close to your heart. The end that hangs outside has a plastic clamp to control the flow of fluids entering or leaving the line. The clamp must always stay closed when the line isn't being used. There is a cap (or connector) at the end of the tube to which a syringe or drip can be attached when needed. The line must remain capped when not in use and can be easily hidden under your clothing.

A central line is used to give chemotherapy, fluids, blood or other medicines directly into your bloodstream and take blood samples. The line can be left in place from several days to several months. If needed, you can go home with it in place.

A central line may not be suitable for you if you have a blood clotting problem. You must tell your doctor if you are taking blood-thinning medicines such as aspirin, warfarin or heparin.

What are the alternatives?

You may be able to have a different type of central line placed in a vein in your arm.

Sometimes you can have medicines or fluids through a plastic tube attached to a needle (cannula) into a vein in your hand.

The type or choice of alternative options available to you will depend on your individual medical needs. Ask your doctor for advice.

Preparing for your procedure

A doctor or specialist nurse usually fits the central line. You may already be in hospital when your line is put in. But, if you are not, you will usually get a letter from your hospital with details of when and where to come for the procedure.

It takes about an hour to fit the central line and it's usually fitted under local anaesthesia. This completely blocks feeling in the skin at the entry site (usually close to the collarbone) and at the exit site (usually in the upper chest area). The entry site is where the line is inserted and the exit site is where one end of the line sits outside the body. You will stay awake during the procedure. You may be given a sedative to help you relax.

You can eat and drink as usual before having a local anaesthetic.

At the hospital your nurse may check your heart rate and blood pressure, and test your urine.

You will usually be asked to sign a consent form. This confirms that you understand the risks, benefits and possible alternatives to the procedure and have given your permission for it to go ahead.

About the procedure

Ultrasound may be used to help guide the central line into the vein.

A small cut is made on the skin near your collarbone and the tip of the line is put into your large vein. The line is 'tunnelled' under the skin to reach the exit site, where part of the line will sit outside the body. Stitches are used to hold the line in place until the skin heals over and holds it naturally. A small cuff on the line just beneath the skin helps to keep it in position.

Stitches may be used to close the entry site and both the entry and exit sites are covered with a clear dressing.

You will have a chest X-ray to make sure the line is correctly positioned.

What to expect afterwards

If you are not staying in hospital for further treatment, you will usually be able to go home when you feel ready.

You will need to arrange for someone to drive you home. You should try to have a friend or relative stay with you for the first 24 hours.

Your nurse will give you some advice about caring for your central line before you go home. You will usually be given a contact number in case you need advice and a date for a follow-up appointment.

Going home with a central line

The entry and exit sites will be numb for several hours. Take special care not to bump or knock the line because it could damage your healing exit site or pull the line out of position. If you catch or pull your line, contact the hospital to have its position checked.

You may need pain relief to help with any discomfort as the anaesthetic wears off. You can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information that comes with your medicine and, if you have any questions, ask your pharmacist for advice.

You will usually need to return to hospital regularly for treatment. During these visits your doctor or nurse will keep a careful check on your line. Your nurse will usually give you a contact number in case you need advice between visits.

The central line will need to be flushed weekly with a salt-water solution (saline) to stop it from getting blocked. The exit site will need to be kept clean and the dressing changed once a week to prevent infection. You may be asked to return to hospital to have this done or a district nurse may visit you at home. You may be shown how to flush the line and change the dressing yourself.

If you develop any of the following symptoms contact your GP or hospital, as you may have developed an infection or the line may be blocked:

high temperature
pain and swelling around the exit site
pain, redness or swelling in your arm, neck or shoulder (usually on the right)
chest pain
breathlessness

The stitches in the entry and exit sites are usually taken out once your skin has healed. You will no longer need a dressing, but you must keep the part of the line that sits outside looped and secured with tape.

What are the risks?

Tunnelled central lines are commonly fitted and generally safe. However, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications of this procedure.

Side-effects

These are the unwanted but mostly temporary effects of a successful procedure. You will feel sore and have some swelling and bruising around the entry and exit sites.

Complications

This is when problems occur during or after the procedure. Most people are not affected. The possible complications of having a tunnelled central line are listed here.

Accidental puncture of an artery - this can cause heavy bleeding and may require surgery to repair any damage.
Accidental puncture of the lung - this may allow air to leak into the chest and you may need to have a tube put in to release the air.
Infection - this can develop inside the catheter or in the exit site. Antibiotics can help to treat the infection but sometimes the line needs to be removed.
Blockage - a blood clot can form and block the catheter. The catheter may need to be removed.
Air in the catheter - you must always keep the clamps and the cap on when the line isn't in use.
Irregular heartbeat - this can happen if the tip of the line is pushed too far into the vein in your heart or if cold fluid is released into your bloodstream too quickly.

The exact risks are specific to you and differ for every person, so we have not included statistics here. Ask your doctor to explain how these risks apply to you.

Further information

Cancerbackup
0808 800 1234
www.cancerbackup.org.uk