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Tunnelled central line

A tunnelled central line (also known as central venous catheter, Groshong, Hickman or long line) is used to give fluids or medicines without the need for repeated injections. It’s fitted inside a vein close to your heart and part of the line sits outside of your body.

You will meet the doctor carrying out your procedure to discuss your care. It may differ from what is described here as it will be designed to meet your individual needs.

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

A central line allows easy access to your blood supply without the need for repeated injections or needles into your vein. A central line is usually recommended if you need to have regular treatment such as antibiotics, chemotherapy or blood transfusions over several weeks or months. The line is tunnelled to reduce the risk of infection.

A central line may not be suitable if you have a blood-clotting problem. Tell your doctor or nurse if you’re taking blood-thinning medicines such as aspirin, warfarin or heparin.

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How a tunnelled central line is placed
Helps ease access to the blood supply without the need for repeated injections or needles into a vein

Details

  • Preparation Preparing to have a tunnelled central line fitted

    A doctor or specialist nurse will fit your central line. You may already be in hospital when your line is put in. If not, the staff at the hospital will tell you where and when to come for the procedure.

    Central lines are usually fitted under local anaesthesia. This completely blocks pain in the affected areas – at the entry site, close to your collarbone and at the exit site, usually in your upper chest. You will stay awake during the procedure and may be given a sedative to help you relax.

    Your doctor or nurse will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to understand what will happen, and you can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the procedure to go ahead, which you may be asked to do by signing a consent form.

  • Alternatives What are the alternatives to a tunnelled central line?

    An alternative to having a central line may be to have an implanted port, which is a thin, soft, plastic tube that is put into a vein in your chest or arm and has an opening just underneath your skin.

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

  • The procedure Having a tunnelled central line fitted

    The procedure usually takes about an hour.

    A small cut is usually made in the skin just below your collarbone and the tip of the line is put into a large vein. Ultrasound may be used to help guide the central line into your vein. The line is then tunnelled under your skin to reach the exit site, where part of the line sits outside your body.

    Stitches or clips 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 your skin helps to keep it in position. The cut below your collarbone is closed with stitches.

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

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  • Aftercare What to expect afterwards

    If you’re 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. Try to have a friend or relative stay with you for the first 24 hours after having your procedure.

    Before you go home, your nurse will give you advice about caring for your central line, hygiene and bathing. You will usually be given a date for a follow-up appointment.

  • Going home with a central line Going home with a central line

    After a local anaesthetic, it may take several hours before the feeling comes back into the affected areas. Take special care not to bump or knock the line as you may pull it out of position and/or damage the exit site. 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. If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information leaflet 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 carefully check your line. Your nurse will usually give you a contact number in case you need advice between visits.

    The central line needs to be flushed once a week, usually with a salt-water solution (saline). The exit site needs 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 have any of the following symptoms, contact your GP or hospital as you may have developed an infection or the line may be blocked.

    • A temperature higher than 37.5°C.
    • Increasing pain and swelling around the exit site.
    • Pain, redness or swelling in your arm, neck or shoulder (usually on the same side as the line).
    • Chest pain.
    • Breathlessness.
    • Bleeding around the line.

    The stitches below your collarbone are removed after seven to 10 days. Stitches at the exit site are taken out once your skin has fully healed, usually after about three weeks. You will no longer need a dressing, but you must keep the part of the line that sits outside looped and secured with tape to stop it from accidentally being pulled.

  • Risks What are the risks?

    As with every procedure, there are some risks associated with having a tunnelled central line fitted. We have not included the chance of these happening as they are specific to you and differ for every person. Ask your doctor to explain how these risks apply to you.

    Side-effects

    Side-effects are the unwanted but mostly temporary effects you may get after having the procedure. You will feel sore and have some swelling and bruising around the entry and exit sites.

    Complications

    Complications are when problems occur during or after the procedure. Most people aren’t affected. The possible complications of having a tunnelled central line are listed below.

    • Infection. This can develop inside the catheter, at the exit site or on a heart valve (endocarditis). Antibiotics can help to treat the infection but sometimes the line needs to be removed.
    • Blockage. A blood clot can form at the tip of the line entering your vein, or the position of the line can change and cause a blockage. If this happens, the line may need to be removed.
    • Air in the line. You must always keep the clamps and the cap on when the line isn't in use.
    • Line failure. Any damage to the line or a change in positioning could cause the line to fail. If this happens, the line needs to be removed urgently.
  • FAQs FAQs

    Can I have a bath with a central line in place?

    Answer

    No, you shouldn't have a bath if you have a central line fitted. You should have a shower instead.

    Explanation

    Submerging the line and the exit area in water can damage the line and increase your risk of infection. Because of this, your doctor will advise you to have showers instead of baths. Your doctor will also advise you not to go swimming for the same reasons.

    You will need to take special care of the exit area and keep it clean to prevent infection. Use an antibacterial body wash for your skin and hair in the shower.

    An infection can be treated with antibiotics but sometimes the line may need to be removed. You must contact the hospital or your GP if you develop any of the following symptoms.

    • A temperature higher than 37.5°C.
    • Increasing pain and swelling around the exit site.
    • Pain, redness or swelling in your arm, neck or shoulder (usually on the same side as the line).

    Having these symptoms may suggest you have developed an infection.

    How is the central line taken out?

    Answer

    Your doctor will take out your central line under local anaesthesia when you don't need it any more.

    Explanation

    One end of your central line sits outside your body. A small cuff on the line just beneath your skin helps to keep it in position. When your central line is no longer needed, your doctor will release the cuff from under your skin and remove the line. A local anaesthetic is injected to numb the area around the cuff and a small cut is made into your skin to reach the cuff and release it. The line is then gently pulled out through the exit site. Pressure is applied to the exit area to stop bleeding and the skin cuts are usually closed with dissolvable stitches.

    The length of time your dissolvable stitches will take to disappear depends on what type you have. However, for this procedure, they usually disappear in about seven to 10 days.

    Will having a tunnelled central line stop me from doing my usual activities?

    Answer

    No, a tunnelled central line won't stop you from doing your usual day-to-day activities. But your doctor will advise you not to swim or do any vigorous gym exercises.

    Explanation

    A central line won't stop you from doing your usual day-to-day activities. However, swimming increases the risk of infection because water can introduce bacteria at the exit site. Also, activities that involve your upper body a lot, such as tennis or golf can move the position of the line and irritate the exit area.

    If the line moves out of position it could cause a blockage. Contact the hospital to have the line's position checked if you catch or pull on it, or if you develop any of following signs.

    • Pain, redness or swelling in your arm, neck or shoulder on the side of the central line.
    • Chest pain.
    • Breathlessness.

    If you enjoy swimming, it’s best to discuss alternatives to tunnelled central line with your doctor. He or she may suggest having an implanted port, which is a thin, soft, plastic tube that is put into a vein in your chest or arm and has an opening just under your skin. This will allow you to go swimming; however, they do leave larger scars.

  • Resources Resources

    Further information


    Sources

    • Central lines (skin-tunnelled venous catheters). Macmillan. www.macmillan.org.uk, published December 2011
    • McCann M, Moore ZEH. Interventions for preventing infectious complications in haemodialysis patients with central venous catheters. Cochrane Database of Systematic Reviews 2010, Issue 1. doi: 10.1002/14651858.CD006894.pub2
    • Bishop L, Dougherty L, Bodenham A, et al. British Committee for Standards in Haematology. Guidelines on the insertion and management of central venous access devices in adults. Int J Lab Haematol 2007; 29:261–78. www.bcshguidelines.com
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  • Author information Author information

    Produced by Krysta Munford, Bupa Health Information Team, September 2012. 

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