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.

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

RISKS:

• There are always risks with any medical procedure. You may have more bleeding than usual or get an infection (in-fek-shun). You could have trouble breathing, or get blood clots. Your caregivers will watch you closely for these problems. Sometimes the tip or end of the catheter will move out of place, or become damaged or blocked. If this happens, you may need to have a new catheter put in.
  
  
• If IV fluid leaks out of the vein into your body, you could get an infection. This may also damage the skin around the catheter. Air could get into your blood through the catheter, or you could get an irregular heartbeat. Rarely, your lung may collapse, or the catheter could break apart inside you and you may die. Call your caregiver if you are worried or have questions about your medicine or care.

WHILE YOU ARE HERE:

Before the Procedure:

• Informed consent: You have the right to understand your health condition in words that you know. You should be told what tests, treatments, or procedures may be done to treat your condition. Your doctor should also tell you about the risks and benefits of each treatment. You may be asked to sign a consent form that gives caregivers permission to do certain tests, treatments, or procedures. If you are unable to give your consent, someone who has permission can sign this form for you. A consent form is a legal piece of paper that tells exactly what will be done to you. Before giving your consent, make sure all your questions have been answered so that you understand what may happen.
  
  
• Blood tests: You may need blood taken for tests. The blood can be taken from a blood vessel in your hand, arm, or the bend in your elbow. It is tested to see how your body is doing. It can give your caregivers more information about your health condition. You may need to have blood drawn more than once.
  
  
• Call button: You may use the call button when you need your caregiver. Pain, trouble breathing, or wanting to get out of bed are good reasons to call. The call button should always be close enough for you to reach it.
  
  
• Gown: A hospital gown is used so that caregivers can easily check and treat you. Caregivers will show you how to put on your gown. When you feel better you may be able to wear your own gown or pajamas.
  
  
• IV: An IV is a tube placed in your vein for giving medicine or liquids. This tube is capped or connected to tubing and liquid.
  
  
• Chest x-ray: This is a picture of your lungs and heart. Caregivers use it to see how your lungs and heart are doing. Caregivers may use the x-ray to look for signs of infection like pneumonia, or to look for collapsed lungs. Chest x-rays may show tumors, broken ribs, or fluid around the heart and lungs.
  
  
• Heart monitor: This is also called an ECG. Sticky pads are placed on different parts of your body. Each pad has a wire that is hooked to a TV-type screen. This shows caregivers a tracing of the electrical activity of your heart.
  
  
• Pulse oximeter: A pulse oximeter is a machine that tells how much oxygen is in your blood. A cord with a clip or sticky strip is placed on your ear, finger, or toe. The other end of the cord is hooked to a machine. Caregivers use this machine to see if you need more oxygen.
  
  
• Vital signs: This includes taking your temperature, blood pressure, pulse (counting your heartbeat), and respirations (counting your breaths). To take your blood pressure, a cuff is put on your arm and tightened. The cuff is attached to a machine which gives your blood pressure reading. Caregivers may listen to your heart and lungs by using a stethoscope. Your vital signs are taken so caregivers can see how you are doing.
  
  
• Anti-anxiety medicine: This medicine may be given to help you feel less nervous and more relaxed.
  
  
• Local or monitored anesthesia: This is a shot of numbing medicine put into the skin where you will have surgery. You may still feel pressure or pushing during surgery but you should not have pain. With local anesthesia, you will be fully awake during the procedure. With monitored anesthesia care, you will also be given medicine through an IV. This medicine keeps you comfortable, relaxed, and drowsy during the procedure.

During the Procedure:

• If the veins near your neck will be used, the head of your bed may be lowered. This helps blood fill up the veins in your neck and chest, making the veins easier to find. You may need hair clipped in the area where your catheter will go. Your caregiver will clean the area where the catheter will go with soap and water. This soap may make your skin yellow, but it will be cleaned off later. Towels will be put over you to keep the area clean. Do not touch the towels or the area that has just been cleaned.
  
  
• Fluoroscopy may be used to put in the catheter so doctors can see that it goes into the right place.Your doctor will make a small incision (cut) through your skin. The catheter will be tunneled under your skin, then put into your vein. Tell your caregivers if you have pain, tingling or aching in your chest, ear or arm. Your doctor can move the catheter to make this stop.
  
  
• An x-ray may be taken to make sure the catheter is in the right place. The doctor will use stitches (thread) to sew the catheter to your skin so it won’t move. Bandages will be put on the incision. This bandage keeps the area clean and dry to prevent infection. If it was lowered, the head of your bed will be raised.

After the Procedure:

• Activity: After the catheter is inserted, you will be taken back to your room or a recovery room. Do not get out of bed until your caregiver says it is OK. At first when you move your neck and shoulder, they may feel stiff or sore.
  
  
• Blood Tests: You may need blood taken for tests. The blood may be taken from the central line. It is taken to check to see how your body is doing. It can give your caregivers more information about your health condition. You may need to have blood drawn more than once.
  
  
• Catheter Cap: You may have one or more tails (tubes) hanging from the place where your catheter was put in. Caps are at the end of these tails to keep the tubes closed and clean. You may be taught how to replace the caps with new ones.
  
  
• Oxygen: You may need extra oxygen to help you breathe easier. It may be given through a plastic mask over your mouth and nose. It may be given through a nasal cannula, or prongs, instead of a mask. A nasal cannula is a pair of short, thin tubes that rest just inside your nose. Tell your caregiver if your nose gets dry or if the mask or prongs bother you. Ask your caregiver before taking off your oxygen. Never smoke or let anyone else smoke in the same room while your oxygen is on. Doing so may cause a fire.
  
  
• Removing the Tunneled Central Line: Your doctor will remove the catheter for you. After it is removed, the catheter is measured to make sure it is all out. You will have a bandage over the area where the catheter was after it is removed. Your tunneled central line may be removed when:
  
  
  • A different type of catheter is needed.
    
    
  • The catheter is causing an infection (in-feck-shun).
    
    
  • You no longer need the IV medicines or treatments.
    
    
  • Your catheter is blocked or no longer works right and cannot be fixed with medicine.

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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