A central line is a long, thin hollow tube. It is put into a vein in your chest and used to give chemotherapy and other drugs.
A central line is a long, thin, hollow tube that can be used to give chemotherapy or other treatments. Central lines are also called skin-tunnelled central venous catheters. Or you may hear them called by brand names, such as Hickman® or Groshong® lines.
A doctor or nurse will put the central line in under the skin of the chest and into a vein close by. One end of the line goes into a large vein just above the heart. The other end comes out of the chest.
The line is usually sealed with a special cap or bung. Your doctor or nurse can attach a drip or syringe to the line to give you medication. There may be a clamp to keep the line closed when it is not being used.
Sometimes, the central line is made up of 2 or 3 fine tubes. These are joined as one tube inside the body and divide into 2 or 3 lines outside the body. This allows you to have different treatments at the same time.
A central line can be used to give you:
- blood transfusions
- intravenous (IV) fluids
- liquid food if you are not able to eat.
It can also be used to take samples of your blood for testing. This means that you will not 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 is also helpful if you do not like needles.
A specialist nurse or doctor will put your central line in at the hospital. You will usually have a local anaesthetic for this, but sometimes a general anaesthetic is used. If you have a local anaesthetic, you may also have sedation to help you relax.
Before the procedure, the doctor or nurse may use a small ultrasound machine to help them find a suitable vein in your neck. Then they clean the skin with an antiseptic solution in the area where the line will be put in.
They numb this area with a local anaesthetic. You should not feel any pain when they are putting the tube in, but you may feel sore for a few days afterwards.
When the area is completely numb, the doctor or nurse will make a small cut in the skin near the collarbone. This is called the insertion site. They will gently thread the tip of the line into a large vein, towards the heart.
They then tunnel the other end of the line under the skin to where it comes out of the body. This is known as the exit site. You will have a chest x-ray to make sure the line is in the right place. The diagram below shows the positions of the central line.
The position of the exit site will vary. You can ask your specialist doctor or nurse to show you where on the 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 afterwards, you may have some pain or discomfort where it has been tunnelled under the skin. You can ask your doctor or nurse which painkillers you should take to help with this.
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 over about 3 weeks. This 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 3 weeks.
When the central line is not being used, there is a small risk of it becoming blocked. To stop this from happening, a nurse will flush a small amount of fluid into the line using a syringe. This is usually done once a week.
To reduce the risk of infection:
- Caps or bungs should be changed every week.
- The exit site needs to be cleaned once a week. If you have a dressing on the site, it will also need to be changed once a week.
- Sometimes, a special dressing, such as an antibiotic disc, may be put over the exit site.
The nurses can teach you how to flush the line and change the dressings. They can also show a family member, partner or friend how to do this.
This needs to be done in a sterile way to avoid infections. Only people who have been trained will be able do this. If you prefer, a district nurse can do it for you at home.
Showers, baths and swimming
When you are at home, it is safe for you to have a shower or bath with your central line.
You can place your line in a plastic bag and tape it to your skin so that the line does not get wet. Or your nurse can give you waterproof dressings to stop the line getting wet. You should keep the exit site out of the water in a bath.
Swimming should usually be avoided because there is a risk of infection. Talk to your doctor if you want to do other sports or activities. This is because there is a risk that your central line could become dislodged. Your doctor or nurse can give you information about the exercises you can do.
It is possible for an infection to develop 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 does not get better, the doctor may remove your line.
It is 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 doctor or nurse immediately 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, your doctor or nurse will give you some medication to dissolve it. Your line may have to be removed.
Blocked central line
The inside of the line can sometimes become partly or completely blocked. If this happens, it can be difficult to give treatment or to take blood tests through it. Your doctor or nurse may flush the line with a solution to try to clear the blockage, or it may need to be removed.
Air in the central line
It is important not to let any air get into your central line. This is not common but can be very serious. The clamps should always be closed when the line is not being used. The line must not be left unclamped when the caps or bungs are not in place.
Groshong® lines do not have clamps. They have a special valve inside the line that stops air getting into it.
A break or cut in the central line
It is important that the central line is not broken or cut. Do not use scissors near the line. Only use the clamp on the thicker, strengthened part of the line.
It is not very common to get a cut or split in the line. If this happens, try to clamp or tie your line just 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 cannot be done, it will be removed.
When you do not need the central line anymore, a doctor or specialist will take it out. This is usually done in the outpatient department and takes about 30 minutes. You will not usually need a general anaesthetic.
Once you are 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 should not be painful.
Once the line is out, your nurse or doctor will put a dressing over the exit site. You will be asked to stay lying down for about 10 minutes until they are sure there is no bleeding.
Below is a sample of the sources used in our chemotherapy information. If you would like more information about the sources we use, please contact us at firstname.lastname@example.org
Brighton, D. Wood, M. The Royal Marsden Hospital Handbook of Cancer Chemotherapy. Elsevier Churchill Livingstone. 2005.
National Institute for Health and Care Excellence (NICE) Neutropenic Sepsis Guideline CG151. 2012.
Perry, MC. The Chemotherapy Source Book (5th ed.) Philadelphia: Lippincott, Williams & Wilkins. 2012.
UKONS Acute Oncology Initial Management Guidelines Version 3, March 2018. Available from www.ukons.org (accessed June 2021).
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Chief Medical Editor, Professor Tim Iveson, Consultant Medical Oncologist.
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