Central lines (skin-tunnelled venous catheters)
Skin-tunnelled venous catheters are often called central lines. They are used to give someone chemotherapy treatment or other medicines.
This is an animation about having a central line (skin-tunnelled venous catheter).
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The information in this video was correct as of 14 May 2014.
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We hope this information answers your questions. If you have any further questions, you can ask your doctor or nurse at the hospital where you are having treatment.
Central lines are long, hollow tubes made from silicone rubber. They are also called skin-tunnelled central venous catheters. Some catheters that are used are Hickman ®
or Groshong ®. Hickman and Groshong are registered trademarks of CR Bard Inc, or an affiliate.
The central line is put in (tunnelled) under the skin of your chest and into a vein close by. One end of the line goes into a large vein just above your heart. The other end comes out of your chest.
The line is usually sealed with a special cap or bung. This can be attached to a drip or syringe containing your medication. There may be a clamp to keep the line closed when it’s not being used.
Sometimes it divides into 2 or 3 lines. This allows you to have different treatments at the same time.
What central lines are used for
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A central line can be used to give you treatments such as chemotherapy, blood transfusions, antibiotics, intravenous (IV) fluids and liquid food if you’re not able to eat.
It can also be used to take samples of your blood for testing. This means that you won't need to have needles put in every time you have treatment.
You can go home with the central line in and it can be left in for weeks or months.
A central line may be helpful if doctors and nurses find it difficult to get needles into your veins. It’s also helpful if you don't like needles.
Your central line will be put in by a specialist nurse or a doctor, at the hospital. This is usually done under a local anaesthetic, but a general anaesthetic is sometimes used.
Your neck will be checked for a suitable vein, using a small ultrasound machine. The area where the line will be put in is then cleaned with an antiseptic solution.
The local anaesthetic is used to numb the area. You shouldn't feel any pain when the tube is being put in, but you may feel a bit sore for a few days afterwards.
A small cut is made in the skin near your collarbone. This is called the insertion site. The tip of the line is gently threaded into a large vein, towards the heart. The other end of the line is then tunnelled under the skin. The tube then reaches the exit site. This is where it comes out of your body. The diagram below shows these positions of the central line.
You will have a chest x-ray to make sure the line is in the right place.
The position of the exit site will vary. You can ask your specialist doctor or nurse to show you where on your chest the exit site is likely to be.
When the line has been put in, you will have dressings covering the insertion and exit sites. For a few days after, you may have some pain or discomfort where it’s been tunnelled under the skin. You can ask your doctor or nurse which painkillers you should take to help with this.
What stops the central line from falling out?
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There is a small cuff around the central line. It can be felt under the skin, just above the exit site. The tissue under the skin grows around this cuff in about three weeks and holds the line safely in place.
Until this happens, you will have a stitch holding the line in place. This stitch usually stays in place for about three weeks.
When the central line isn't being used, there is a small risk of it becoming blocked. To stop this from happening, a small amount of fluid is flushed into the line using a syringe. This is usually done once a week. The caps or bungs at the end of each line should also be changed every week.
The exit site needs to be cleaned once a week to reduce the risk of infection. If you have a dressing on the site, it will need to be changed once a week. To help reduce the risk of infection, an antibiotic patch may be put around the exit site.
If you feel able, the nurses at the hospital will teach you how to flush the line and change the dressings. They can also show a relative, partner or friend how to do this. If you prefer, a district nurse can do it for you at home.
When you’re at home, it’s safe for you to have a shower or bath with your central line in.
Your nurse can give you waterproof covers to stop the line getting wet.
Possible problems with central lines
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It’s possible for an infection to develop either inside the central line or around the exit site. Contact your hospital doctor or nurse if you have:
swelling, redness or pain at the exit site
discoloured fluid coming from the exit site
a high temperature (fever).
If you get an infection, your doctor will prescribe you antibiotics. If the infection doesn’t get better, the line may be removed.
It’s possible for a blood clot (thrombosis) to form in your vein at the end of the line. You may be given medication to help prevent this. Contact your hospital doctor or nurse if you have:
swelling, redness or tenderness in the arm, chest area or up into the neck (on the same side as the central line)
shortness of breath
tightness in your chest.
If a clot does form, you will be given some medication to dissolve it. Your line may have to be removed.
Air in the central line
It’s important not to let air get into your central line. The clamps should always be closed when the line isn’t being used. The line must not be left unclamped when the caps or bungs aren't in place.
Groshong ® lines don't have clamps. They have a special valve inside the line that stops air getting into it.
Break or cut in the central line
It's important that the central line is not broken or cut. Don’t use scissors near the line. Only use the clamp on the thicker, strengthened part of the line.
It's not very common to get a cut or split in the line. If this happens, try to clamp or tie your line immediately above the break. This is to seal it between the split and where the line comes out of your body. Contact your hospital straight away. The nurses may be able to repair the line. If this can't be done, it will be removed.
When you don’t need the central line anymore, it will be taken out. A doctor or specialist nurse will do this for you. It’s usually done in the outpatient department and takes about 30 minutes. You won't usually need a general anaesthetic.
Once you’re lying down comfortably, the skin over your chest will be cleaned with antiseptic. The doctor or nurse will then numb the area around the cuff with local anaesthetic. They will make a small cut to release the cuff, then slowly remove the line. You might find this uncomfortable, but it shouldn't be painful.
Once the line is out, your nurse or doctor will put a dressing over the exit site. You’ll be asked to stay lying down for about 10 minutes until they are sure there is no bleeding.
This information has been compiled using information from a number of reliable sources, including:
Bishop, et al. Guidelines on the Insertion and Management of Central Venous Access Devices in Adults. International Journal of Laboratory Haematology. 2007.
British Committee for Standards in Haematology. Guidelines on the insertion and management of central venous access devices in adults. 2006.
Dougherty, et al. The Royal Marsden Hospital Manual of Clinical Nursing Procedures. 8th edition. 2011. Wiley – Blackwell.
Perry MC. The Chemotherapy Source Book. 4th edition. 2008. Lippincott Williams and Wilkins.
Thank you to Ms Elaine Chapman, Lead Chemotherapy Nurse who reviewed this edition and all of the people affected by cancer who reviewed what you're reading and have helped our information to grow.
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