Tunneled Central Lines Child

WHAT YOU SHOULD KNOW:

• A tunneled central line is a type of catheter. A catheter is a small flexible plastic tube. The catheter is tunneled a short distance under your child's skin before it enters a large vein. Your child's doctor may put the catheter into a vein near your child's shoulder or neck. A vein is a blood vessel that moves blood through your child's body.
  
  
• Where the catheter comes out of the skin, there may be up to three small tails (tubes) hanging out. These tails have caps and clamps on them. With a central line, your child may have blood taken for tests and get IV medicines. Having a central line may keep your child from being stuck with a needle many times.

CARE AGREEMENT:

You have the right to help plan your child's care. To help with this plan, you must learn about central lines. You can then discuss choices with your child's caregivers. Work with them to decide what choices may be best for your child.

RISKS:

• Your child 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 the chest and cause heart or lung problems. Your child may get an infection where the catheter enters his body, or the infection may be in his bloodstream. The catheter may break, bend, or move out of place and not work. It may need to be taken out, and a new catheter put in.
  
  
• Medicine may leak on your child's 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. Your child may get a blood clot in the vein where the catheter is placed. This can cause pain and swelling, and it can stop blood from flowing where it needs to go in his body. The blood clot may break loose and travel to the lungs. A blood clot in the lungs can cause chest pain and trouble breathing. This problem can be life-threatening.
  
  
• If your child does not have a central line placed, he may not be able to get the medicine or treatment that he needs. Rather than having blood samples collected from the catheter, blood may need to be collected by a needle stick into your child's vein. Veins may get damaged if medicines or treatments that are harmful to smaller veins are given through a regular IV instead of a central line. Talk to your child's caregiver if you have questions or concerns about the risks of having a tunneled central line inserted.

WHILE YOU ARE HERE:

Before the procedure:

• Informed Consent:
  
  
  • You have the right to understand your child's health problem. You should understand what tests, treatments, or procedures may be done to treat your child's problem. Your child's caregiver should also tell you about the risks and benefits of each treatment.
    
    
  • You may be asked to sign a consent form. If you are unable to give your consent, someone who has permission can sign this form for your child. A consent form is a legal paper that gives a caregiver permission to do certain tests, treatments, or procedures. This form should tell you exactly what will be done to your child. Your child's caregiver should explain what the risks and benefits of each treatment are before you sign the form. Before giving your consent, make sure all your questions have been answered. This way you will understand what may happen to your child.
  
  

• Blood tests: Your child may need blood taken for tests. The blood may be taken from your child's arm, hand, finger, foot, heel, or IV. Your child may need to have blood drawn more than once.
  
  

• Call button: A call button will be in your child's hospital room. You or your child should use the call button if your child is having problems and a caregiver is needed. You can also use the call button if you or your child have questions for a caregiver. Be sure to keep the call button near you or your child at all times.
  
  

• Chest X-ray: This is a picture of your child's lungs and heart. Caregivers use it to see how your child's lungs and heart are doing. The chest x-ray can show problems such as: pneumonia, tumors, fluid around the heart, or a collapsed lung. It also shows caregivers if the catheter is in the right place.
  
  

• Heart monitor: This is a machine used to see how your child's heart is doing. Some small sticky pads are placed on your child's chest. Each pad has a wire that is hooked to a TV-type screen or to a small portable box. This screen or box shows a picture of your child's heartbeat. Caregivers watch this picture to make sure your child's heart is doing well.
  
  

• Pulse oximeter: This is a machine that tells caregivers how much oxygen is in your child's blood. A cord with a clip or sticky strip is placed on your child's foot, toe, hand, finger, or earlobe. Tell a caregiver if the sticky strip or clip comes off of your child. The machine will alarm if the machine cannot read the oxygen level or if your child needs more oxygen. Tell a caregiver if the machine is alarming. Never turn the pulse oximeter off unless a caregiver has said it is OK.
  
  

• Vital signs: This may include taking your child's temperature, pulse (heartbeats), respirations (breaths), and blood pressure. Your child's temperature may be taken in the mouth, ear, armpit, or rectum. Caregivers may also listen to your child's heart and lungs by using a stethoscope.
  
  

• General anesthesia: This is medicine to make your child comfortable and sleep during the procedure. The medicine may be given as a liquid or in an IV. It can also be given as a breathing gas through a face-mask. It may also go through a tube placed in your child's mouth and throat. This tube is called an endotracheal tube or "ET tube". Ask your child's caregiver for more information about anesthesia.
  
  

During the procedure:

Your child lies on his back, and the table may be tipped so that his head is slightly lower than his feet. Ultrasound and fluoroscopy may be used to help guide placement of the catheter. Caregivers wash their hands, and wear sterile (germ-free) gowns, masks, caps and gloves to help prevent infection. The skin where the catheter will be placed is cleaned well with germ-killing soap, and your child is covered with a clean sheet. The caregiver inserts a needle through your child's skin until the needle reaches his vein. A guidewire is used to help place the catheter in the vein. A catheter that contains or is coated with germ-killing medicine may be used to help prevent infection. The needle and guidewire are removed, and the catheter is left in the vein. Caregivers secure the catheter to your child's 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 the procedure:

• Chest x-ray: A chest x-ray may be done to check the location of the catheter.
  
  
• Activity: Your child's caregiver will tell you when it is okay to pick up your child. At first, your child's neck and shoulder may be sore.
  
  
• Catheter care: Your child may have one or more tails hanging from the place where the 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. Caregivers will flush your child's catheter with saline solution, heparin medicine, or both. Saline and heparin are used to help keep the catheter open and clear. Heparin may help prevent blood from clotting inside the catheter.

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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.

Learn more about Tunneled Central Lines Child (Inpatient Care)