Tunneled Central Lines

What Are Tunneled Central Lines?

A tunneled central line is a type of central line. A central line (also called a central venous catheter) is like an intravenous (IV) line. But it is much longer than a regular IV and goes all the way up to a vein near the heart or just inside the heart.

A patient can get medicine, fluids, blood, or nutrition through a central line. It also can be used to draw blood.

How Does a Tunneled Central Line Work?

Tunneled central lines (also called external central lines) go in through the skin near the collarbone:

1. The line is tunneled under the skin and into a vein.
2. Then, it's threaded through the vein.
3. It ends in a large vein near the heart or just inside the heart.

The other end of the line stays outside the body, usually on the chest. It may divide into more than one line. The end of each line is covered with a cap. Health care providers attach syringes (a tube with a plunger) to the caps when they give medicine or draw blood. No needles are used, so there's no pain.

The two main types of external lines are Broviacs or Hickmans.

When Are Central Lines Used Instead of Regular IV Lines?

Central lines are thicker and more durable than a regular IV. They're also much longer and go farther into the vein. Doctors use a central line instead of a regular IV line because:

• It can stay in place longer (up to a year or even more).
• It lowers the number of needle sticks a child needs for blood draws.
• Patients can get large amounts of fluids or medicines (like chemotherapy) that might not go through regular IVs.

A central line can help someone who:

• has a serious infection so they can get IV for a few weeks
• has cancer so they can get chemotherapy and blood tests through the line
• needs IV nutrition
• needs many blood transfusions

How Is a Tunneled Central Line Placed?

Doctors place tunneled central lines in an operating room, intensive care unit, or interventional radiology suite. The patient is sedated (given medicine to relax) or gets general anesthesia (to go to sleep) so they won't feel pain.

To place the line, a doctor will:

1. Clean and numb the skin where the line goes in.
2. Put the line into a vein in the chest using ultrasound to guide where the line goes.
3. Thread the line into a large vein near the heart or just into the heart.
4. Check the placement of the line with an X-ray.
5. Place a dressing (bandage) over the tunneled central line.

Are There Risks to a Central Line?

Most of the time, there are no problems with a central line. If problems do happen, it is usually because the line gets infected or stops working. Very rarely, a central line can cause a blood clot. Doctors review the risks with families before placing the central line.

When Should I Call the Doctor?

Check the central line area every day and call the doctor right away if:

• There are signs of an infection, such as:
  • a fever
  • redness or swelling near where the line is
  • pain or tenderness where the line is
• The line comes out or gets blocked (can't be flushed).

How Can Parents Help?

At home, a child's tunneled central line needs special care to prevent infection and keep it working well. It's normal to feel a little bit nervous caring for the line at first, but soon you'll feel more comfortable. You'll get supplies to use at home, and a visiting nurse may come to help you when you first get home.

Before your child goes home, ask your health care team:

• how often to change the dressing
• when and how to flush the line
• what to do if the line gets blocked or comes out
• how to give medicines through the line (if you will be giving medicines at home)
• if the line has caps, how often to change them
• which physical activities are OK for your child (most kids need to avoid rough play and contact sports)
• if any special care is needed to protect the tunneled central line while your child bathes
• what signs of infection to watch for

Tell your child's teachers, school nurse, counselor, and physical education teacher about the tunneled central line. They can make sure your child avoids any activities that may damage the line, and help support your child during treatment.