Tunnelled central line

Published by Bupa's Health Information Team, October 2010.

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

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 is fitted into a vein close to the heart and part of the line sits outside the body.

You will meet the doctor or nurse 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.

Animation - How a tunnelled central line is placed

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About tunnelled central lines

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 in 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.

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

What are the alternatives?

Alternatives to a tunnelled central line include having a different type of central line placed in a vein in your arm or a cannula (a plastic tube attached to a needle) into a vein in your hand. Another option may be to have an implanted port - a thin, soft, plastic tube that is put into a vein in your chest or arm and has an opening (port) just under the skin.

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 will fit your central line. You may already be in hospital when your line is put in. If not, your hospital will tell you when and where 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 usually close to the collarbone and at the exit site usually in the upper chest area). 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.

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.

About the procedure

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 'tunnelled' under the skin to reach the exit site, where part of the line sits outside the 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 the skin helps to keep it in position. The cut below your collarbone is closed with stitches.

You will usually have a chest X-rays 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. 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

After a local anaesthetic it may take several hours before the feeling comes back into the treated areas. Take special care not to bump or knock the line because it could pull the line 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 because 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

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.

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 below.

• Accidental puncture of an artery - this can cause heavy bleeding and may need 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.
  
• Poor positioning of the line - this can sometimes cause it to break, and can result in irregular heartbeats - if this happens, the line needs to be removed urgently.
  
• Infection - this can develop inside the catheter, in 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 and block the line. 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.

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.

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.