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.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

Risks

• You may bleed more than expected, or the catheter may go into the wrong area or blood vessel during the procedure. Air or blood may get into the pleural (lung) cavity in your chest, causing heart or lung problems. You may get an infection where the catheter enters your body, or in your bloodstream. The catheter may break, bend, or move out of place, and not work. You may need to have the catheter removed, and a new one placed.
  
  
• Medicine may leak on your skin, causing swelling, pain, blisters, and tissue damage. 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. You may get a blood clot in your leg or arm. This can cause pain and swelling, and it can stop blood from flowing where it needs to go in your body. The blood clot may break loose and travel to your lungs. A blood clot in your lungs can cause chest pain and trouble breathing. This problem can be life-threatening.
  
  
• If you do not have a central line placed, you may not be able to get the medicines or treatments that you need. Caregivers will have to collect blood samples using a needle stick into your vein. If medicine that harms small veins is given through a regular IV, your veins may be damaged. Talk to your caregiver if you have questions about the risks of having a tunneled central line inserted.

Getting Ready

Before your procedure:

• Ask your caregiver if you need to stop using aspirin or any other prescribed or over-the-counter medicine before your procedure or surgery.
  
  
• Bring your medicine bottles or a list of your medicines when you see your caregiver. Tell your caregiver if you are allergic to any medicine. Tell your caregiver if you use any herbs, food supplements, or over-the-counter medicine.
  
  
• Tell your caregiver if you have a history of problems with blood clotting. Tell caregivers if you have had a central line before.
  
  
• You may need to have a vascular ultrasound. This type of ultrasound uses sound waves to show pictures of your blood vessels. Ask your caregiver for more information about this or any other test you may need. Write down the date, time, and location of each test.
  
  
• Blood tests: You may need blood taken to give caregivers information about how your body is working. The blood may be taken from your hand, arm, or IV.

The day of your procedure:

• Write down the correct date, time, and location of your procedure.
  
  
• You or a close family member will be asked to sign a legal document called a consent form. It gives caregivers permission to do the procedure or surgery. It also explains the problems that may happen, and your choices. Make sure all your questions are answered before you sign this form.
  
  
• An anesthesiologist may talk to you before your surgery. This caregiver may give you medicine to make you sleepy before your procedure or surgery. Tell your caregiver if you or anyone in your family has had a problem using anesthesia in the past.
  
  
• You may be given sedative medicine to help you remain calm and relaxed during the procedure.

Treatment

What will happen:

• You will lie on your back for the procedure. The table may be tipped so that your head is slightly lower than your feet. Ultrasound and fluoroscopy may be used to help guide placement of the catheter. Caregivers will wash their hands, and wear sterile (germ-free) gowns, masks, caps, and gloves. Germ-killing soap is used to clean your skin where the catheter will be placed. You are covered with a clean sheet. These tasks are done to help prevent infection. Local anesthesia medicine will be used to numb the area where the catheter will be inserted. You may get general anesthesia medicine to make you sleep.
  
  
• Your caregiver inserts a needle through your skin until the needle reaches your vein. A guide wire is used to help place the catheter in your vein. A catheter that contains or is coated with germ-killing medicine may be used to help prevent infection. The needle and guide wire will be removed, and the catheter left in the vein. Caregivers will secure the catheter to your skin using tape, stitches, or a special lock. A new bandage is placed over the area to keep it clean and help prevent infection.

After your procedure:

You will need to rest for a period of time. Do not get out of bed until caregivers say that it is okay. You may need to have a chest x-ray. The central line will be flushed with saline solution, heparin medicine, or both. Saline and heparin are used to help keep the catheter open and clear. Heparin may help stop blood from clotting inside the catheter.

Contact a caregiver if

• Your signs and symptoms are getting worse.
  
  
• You have a fever.
  
  
• You cannot make it to your procedure.

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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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