Tunneled Central Lines Adult

WHAT YOU SHOULD KNOW:

• A central line is a type of intravenous (IV) catheter. A catheter is a tube that is placed in your body and used to give medicines and treatments. A tunneled central line is a catheter that is tunneled underneath your skin before it enters a large vein. Veins are blood vessels in the body that carry blood to your heart. The central line may be put into your skin near your shoulder, neck, or groin. A central line has one or more short tails, or lumens, coming from it that hang on your skin. Having more than one lumen allows you to get more than one medicine or treatment at a time.
  
  
• A central line can stay in place to give medicines, liquids or treatments for weeks, months, or even years. A tunneled central line can be used to give medicines or liquids that would harm smaller veins. You may need a central line if the veins in your arm are small or damaged and cannot be used. Antibiotics (medicine to fight infection) or chemotherapy (medicine to treat cancer) may be given through a tunneled central line. Total parenteral nutrition (TPN), or blood may also be given through the central line. A tunneled central line may be used to collect blood samples, or to give dialysis treatments. Dialysis treatments clean waste from your blood if your kidneys are not working the way they should. A tunneled central line provides a way for you to get the medicines and treatments that you need.

AFTER YOU LEAVE:

Take your medicine as directed:

Call your primary healthcare provider if you think your medicine is not working as expected. Tell him if you are allergic to any medicine. Keep a current list of the medicines, vitamins, and herbs you take. Include the amounts, and when, how, and why you take them. Take the list or the pill bottles to follow-up visits. Carry your medicine list with you in case of an emergency. Throw away old medicine lists.

• Keep a current list of your medicines: Include the amounts, and when, how, and why you take them. Take the list or the pill bottles to follow-up visits. Carry your medicine list with you in case of an emergency. Throw away old medicine lists. Use vitamins, herbs, or food supplements only as directed.
  
  
• Take your medicine as directed: Call your primary healthcare provider if you think your medicine is not working as expected. Tell him about any medicine allergies, and if you want to quit taking or change your medicine.
  
  
• Nonsteroidal anti-inflammatory medicine: This family of medicine is also called NSAIDs. This medicine may help decrease pain and redness where the catheter enters your skin. You can buy NSAIDs with or without a prescription. NSAIDs can cause stomach bleeding or kidney problems in certain people. Always read the medicine label and follow the directions on it before using this medicine.
  
  
• Saline: A solution called saline may need to be flushed through your central line. This liquid may help keep the catheter open and clear.
  
  
• Heparin: A solution called heparin may need to be flushed through your central line. Heparin is medicine that helps prevent blood clots from forming inside the catheter. If heparin is used to flush the catheter, problems including allergic reaction, bleeding, and heparin-induced thrombocytopenia (HIT) could develop. HIT is a low number of blood platelets, which increases the risk of bleeding.
  
  
• Home IV medicines: Ask caregivers for information about the medicines and treatments that you need at home. Medicines may be brought to your home. Read the labels on your medicine. Ask your caregiver if your medicine needs to be stored in the refrigerator. Follow your caregiver's directions to give yourself medicine through the catheter.
  
  
• TPN: TPN stands for total parenteral nutrition. It is also called hyperalimentation. It provides your body with nutrition such as protein, sugar, vitamins, minerals, and sometimes fat (lipids). TPN is used when you have problems with eating or digesting food. TPN is usually put into your body through a large IV catheter, such as a central line. You may need TPN for several days or longer.

Using a medicine pump:

Your medicine may need to be given through the central line using a pump. You may be taught to prepare and attach your medicine to the pump. Caregivers will teach you how to use your pump. Ask caregivers what to do when the alarm sounds, and how to care for the pump.

Ask for information about where and when to go for follow-up visits:

For continuing care, treatments, or home services, ask for more information.

• Stitches may have been used to keep the catheter in place. Your caregiver may take out the stitches.
  
  

Hand washing:

Always wash your hands with soap and water before touching the central line or the area around it. Washing your hands helps prevent infection. Ask caregivers for information about hand hygiene. Do not touch or handle your catheter unless you need to give medicine or care for the catheter. Wash your hands and put on new medical gloves before touching or handling your catheter.

Activity guidelines:

Do not go swimming. Swimming exposes your central line to germs that can cause infection. It is better to take showers, rather than baths, while you have a central line in place. Ask your caregiver about other activity guidelines when you have a central line.

Caring for your tunneled central line:

• The place where the catheter is inserted must be checked daily for signs of infection and other problems. Your skin must be cleaned before every bandage change. The bandage over the area, and the caps on the catheter lumens, must be changed. The tubing used to give medicines or liquids must also be changed. Ask your caregiver how often these tasks need to be done, and who will do them. If you need to do any of these tasks, ask caregivers for written directions.
  
  
• Your central line may need to be flushed. This is when you push a small amount of liquid through the central line using a syringe. This liquid may be saline, heparin, or both. Flushing is done to help prevent your catheter from getting blocked. Flushing is also done to help prevent medicines from mixing with each other in the tubing. If you need to flush your catheter, ask caregivers what solution to use. Ask them to show you how to flush your catheter correctly.

Removing or replacing the tunneled central line:

• The catheter may need to be removed if you get an infection, or the catheter gets damaged. If you get a blood clot, you may need to have the catheter removed. Blood tests may be done before the catheter is taken out. If you need more medicine or treatments after the central line is removed, another central line may be put in.
  
  
• Caregivers will remove the central line. To do this, you will lie on your back on a table. The table may be tipped so that your legs are raised higher than the level of your head. Medicine may be used to numb your skin where the catheter goes in. A cut may be made on your skin to loosen the catheter from the tissue. You may be asked to exhale (breathe out), blow into a device, or bear down like you are having a bowel movement. As you do that, your caregiver will gently pull the central line out. Caregivers will apply pressure to the area, and then secure a bandage over it. You will need to rest for at least 30 to 60 minutes after the catheter is removed. Leave the bandage in place until you talk to or meet with your caregiver.

CONTACT A CAREGIVER IF:

• You have questions about your condition or care.
  
  
• You have a fever.
  
  
• You feel pain in your arm, neck, shoulder, or chest on the side of your body that the catheter is in.
  
  
• Your arm, neck, or face is swollen and red on the side that your catheter is in.
  
  
• The area around where the catheter enters your body is painful, looks red or swollen, or feels firm or hard.
  
  
• You notice liquid, blood, or pus leaking from the area where the catheter enters your skin.

• You feel pain when liquid is going into your central line.
  
  
• You have chest pain or trouble breathing that is getting worse over time.
  
  
• It is hard to get medicines to go into your catheter, or they have started going in much slower. Check for, and gently straighten any kinks in the tubing. See if doing this helps the medicine flow in more easily. If straightening the tubing does not make the medicine flow in more easily, call your caregiver.
  
  
• You see air in the tubing.
  
  
• You see that the catheter lumens hanging outside of your body are getting shorter or longer.
  
  
• There is new or more blood on your bandage.
  
  
• Your bandage gets wet, loose, or dirty, or falls off, and you do not know how to change it.
  
  
• You run out of supplies to care for your central line.
  
  
• After the central line is removed, you see redness, swelling, or pus (thick fluid) coming from the area, or the area is painful. Call caregivers if you get a cough or fever.

SEEK CARE IMMEDIATELY IF:

• Your arm or leg feels warm, tender, and painful. It may look swollen and red.
  
  
• You suddenly feel lightheaded and have trouble breathing.
  
  
• You have new and sudden chest pain. You may have more pain when you take deep breaths or cough. You may cough up blood.
  
  
• The area where the central line enters your skin looks red, feels warm or painful, and is leaking fluid.
  
  
• You see blisters on the skin where the catheter enters it.

• Your central line falls out, or is pulled out by accident.
  
  
• After the central line is removed, you feel lightheaded or confused, have trouble breathing or chest pain, or you faint.

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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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