Tunneled Central Lines Adult

WHAT YOU SHOULD KNOW:

• A tunneled central line is also called a catheter (kath-uh-ter). A catheter is a small flexible plastic tube. The catheter is put in through and then tunneled under your skin a short distance. Your doctor may put the catheter into a vein near your neck. It then enters a large vein by your heart. A vein is a tube inside you that carries blood from your body to your heart. The other end of the catheter usually exits the skin on your chest below the collarbone.
  
  
• You may have 1 to 3 small tails (tubes) hanging out from where the catheter was put in. These tails may have caps and clamps on them. With a central line, you may have blood taken for tests, and get IV fluids. Having a central line may keep you from being stuck with a needle many times.

AFTER YOU LEAVE:

Medicines:

• Keep a written list of the medicines you take, the amounts, and when and why you take them. Bring the list of your medicines or the pill bottles when you see your caregivers. Learn why you take each medicine. Ask your caregiver for information about your medicine. Do not use any medicines, over-the-counter drugs, vitamins, herbs, or food supplements without first talking to caregivers.
  
  
• Always take your medicine as directed by caregivers. Call your caregiver if you think your medicines are not helping or if you feel you are having side effects. Do not quit taking your medicines until you discuss it with your caregiver. If you are taking medicine that makes you drowsy, do not drive or use heavy equipment.

Activity: Ask your caregiver if you should change the way you do everyday activities. Never pull on the catheter tails, and avoid getting them caught on things like clothing.

Air in the Catheter: Air should not get into your catheter. Make sure that the extension tubing, syringe, and needle are all tightly connected. You may also tape these connections so they stay together. Ask your caregiver to show you how.

Appointments:

Ask your caregiver when to return for a follow-up visit. Keep all appointments. Write down any questions you may have. This way you will remember to ask these questions during your next visit.

Bandages: Your caregiver should change the bandage over your catheter, or you may be taught to change it yourself. The bandage must be sterile and the area covered at all times until the site is completely healed. The bandage may get loose or come off. If you have not been taught how to change it, call your caregiver. Bandages are usually changed 1 to 2 times a week.

Bathing:

• When your catheter area is completely healed you may cover it with a clean bandage, or you may not need a bandage. Ask your caregiver. Healing is usually complete in about 4 weeks.
  
  
• After the area is healed, you may shower or bathe when you are not using your catheter. You will not need to cover it with plastic. Gently wash the area with mild soap and water, and then rinse and dry it well. If you use a bandage, put on a new one after you have finished bathing. Change it whenever it gets wet or dirty. If you want to swim, check with your caregiver.

Catheter Blockage: If your catheter is blocked, it may be hard to push in the plunger (the inside part of the syringe). If this happens, do not force the plunger. This could damage the catheter or break off a blood clot into your body. Call your caregiver right away. Follow caregiver’s instructions for flushing your catheter to keep it from getting blocked.

Flushing:

• Ask your caregiver what medicine to use to flush the catheter. Saline solution is often used. Ask him when and how often to flush the catheter. Flushing means to push fluid out of a syringe. To do this, screw or push a syringe into the plastic end of your catheter tail. Use the plunger to slowly push the fluid out of the syringe into the catheter. Always clean the catheter cap as your caregiver has shown you before using it.
  
  
• Usually you will follow the "SASH" rule for flushing. This is S aline solution, followed by the A ntibiotic (or other medicine). Then when the medicine has finished, flush with S aline solution, then finish by flushing with H eparin. If you have a Groshong (grow-shong) catheter, heparin may not be used for flushing.
  
  
• Your caregiver may ask you to check the length of the tails from your catheter. If the length is more or less than what it was, call your caregiver. If you are not using your catheter for medicines or fluids you still need to flush it, but not as often. Ask your caregiver when and how you should flush your catheter when you are not using it.

Medicine Pump: You may get your medicine all the time through a pump. If so, you do not need to unhook and flush your catheter. You may be taught to prepare and hook containers of medicine to the pump.

Heat: After the first 24 to 48 hours you may use heat to lessen pain or swelling. Heat brings blood to the surgery area and helps it heal faster. Use a heating pad (turned on low) or a hot water bottle. Make sure you wrap the hot water bottle in a towel. Do this for 15 to 20 minutes out of every hour as long as you need it. Do not sleep on the heating pad or hot water bottle. This could cause a bad burn.

Infusion center: An infusion center is a place where you may go to get IV medicines or treatments. Some catheters can be put in and removed there. If you are having problems with your IV, you may go to an infusion center to get help.

Needleless IV system: A needleless intravenous (IV) system is used to give fluid and medicine in your IV line. It may sometimes be used to take blood out of your IV line also. With a needleless system, there are no needles used and there is no chance of poking yourself. Plastic ends of your medicine container or syringes are pushed or screwed into the caps on your catheter tails.

Pain: Any pain and swelling should go away in 1 to 2 days. The area around the catheter may be stiff. This should also go away in 1 or 2 days.

Using your Tunneled Central Line: A caregiver may come to your home or you may go to an Infusion Center or clinic to get medicines and fluids through your central line. You may be taught how to do this yourself. Following are steps for using your tunneled central line:

• Gather all the supplies you will need. Wash your hands well with soap and water. Put on clean plastic gloves if you have them.
  
  
• If you have more than one tail (tube) hanging out, pick the tail that you should use. Your caregiver will tell you which tails to use for which medicines.
  
  
• Prepare the medicine that you will be taking. Some medicines have to be kept in the refrigerator. You may need to take the medicine out before you use it so that it warms up.
  
  
• Clean the end of your catheter tail and the syringe with alcohol or as shown by your caregiver. Do not touch the cap or syringe tip or let them touch anything after they have been cleaned.
  
  
• Hold the syringe with flush liquid in one hand. With the other hand hold the catheter tail. Screw or push the ends together firmly. Unclamp the tail that you are using. Flush the catheter as shown by your caregiver.
  
  
• Remove the syringe from the catheter, and clean the cap on the catheter tail with alcohol.
  
  
• Screw or push the end attached to the bag of IV medicine or liquid into the catheter end. Start the pump that infuses the medicine or liquid, or adjust the flow of the medicine. Be sure the tubing is not clamped, split or kinked. The liquid should go in at the speed shown by your caregiver.
  
  
• If your medicine comes in a syringe, screw or push the syringe on to the catheter cap. Be sure it is on tight. Push the medicine into the catheter slowly over the length of time shown by your caregiver.
  
  
• When the right amount of liquid has gone in, unscrew or pull apart the two ends. Flush the catheter as shown by your caregiver. You may have to flush the catheter 2 times with different liquids. Close the clamp on the catheter tail.

Wellness hints:

• Eating and drinking:
  
  
  • Eat a variety of healthy foods such as fruits, vegetables, whole-grain breads, low-fat dairy products, beans, lean meat and fish. Eating healthy foods may help you have more energy and heal faster. Ask your caregiver if you need to be on a special diet.
    
    
  • Men 19 years old and older should drink about 3.0 Liters of liquid each day (close to 13 eight-ounce cups). Women 19 years old and older should drink about 2.2 Liters of liquid each day (close to 9 eight-ounce cups). Follow your caregiver's advice if you must change the amount of liquid you drink. For most people, good liquids to drink are water, juices, and milk. If you are used to drinking liquids that contain caffeine, such as coffee, these can also be counted in your daily liquid amount. Try to drink enough liquid each day, and not just when you feel thirsty.
  
  
• Start exercising: Talk to your caregiver before you start exercising. Together you can plan the best exercise program for you. It is best to start slowly and do more as you get stronger. Exercising can help make your heart stronger, lower your blood pressure, and keep you healthy.
  
  
• Quit smoking: It is never too late to quit smoking. Smoking harms the heart, lungs, and the blood. You are more likely to have a heart attack, lung disease, and cancer if you smoke. You will help yourself and those around you by not smoking. Ask your caregiver for more information about how to stop smoking if you are having trouble quitting.
  
  
• Avoid stress: Stress may slow healing and cause illness. Since it is hard to avoid stress, learn to control it. Learn new ways to relax, such as deep breathing. Talk to your caregiver about things that upset you.

CONTACT A CAREGIVER IF:

• You have a fever (increased body temperature).
  
  
• While getting medicine through your new catheter, you feel itchy or get a rash. This may be a sign of an allergy (al-er-g) to your medicine. If this happens, stop the medicine and call your caregiver right away.
  
  
• It is hard to get medicines to go into the catheter, or they have started going in much more slowly.
  
  
• Your stitches or the area around the catheter is swollen, red, warm, or has drainage. These are signs of infection.
  
  
• There is a warm, red, tender, swollen area that goes along the line where your catheter is tunneled.
  
  
• There is swelling and the skin around the catheter is painful and cool.
  
  
• You have pain in your shoulder, arms, and neck that does not go away or gets worse.
  
  
• You have pain when a liquid goes into your catheter.
  
  
• You have questions or concerns about your catheter.
  
  
• Your face, neck, arm or chest is swollen.

SEEK CARE IMMEDIATELY IF:

• You feel chest pain. This might be a sign of a blood clot, heart attack or problems with your lungs.
  
  
• You have trouble breathing or your skin turns blue or pale. Air may have gotten into your catheter. You should:
  
  
  • Clamp (pinch off) the catheter where it enters your skin.
    
    
  • Lie down on your left side with your head down and your feet raised. Stay in this position until your caregiver tells you it's OK to get up.
    
    
  • Call 911 or 0 (operator) for an ambulance to get to the nearest hospital or clinic. Do not drive yourself!

Copyright © 2008 Thomson Healthcare Inc. All rights reserved. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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