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.

Getting Ready

The night before the procedure:

• Your child may need blood tests before the procedure. Talk to your child's caregiver about these or other tests he may need. Write down the date, time, and location for each test.
  
  
• Ask caregivers about directions for eating and drinking.

The day of the procedure:

• Write down the correct date, time, and location of your child's procedure.
  
  
• Ask your child's caregiver before giving your child any medicine or food on the day of the procedure.
  
  
• You will be asked to sign a legal piece of paper (consent form). It gives your child's caregiver permission to put in the central line. Be sure all your questions have been answered before you sign this form.

Treatment

• Your child will lie on his back for the procedure. 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 will wash their hands, and wear sterile gowns, masks, caps and gloves to help prevent infection. Your child's caregiver will clean the skin where the catheter will be placed well, using germ-killing soap. Your child will be covered with a clean sheet. Local anesthesia medicine will be used to numb the area where the catheter will be inserted. Your child may get general anesthesia to make him sleep.
  
  
• The caregiver will insert a needle through your child's skin until the needle reaches the vein. A guide wire 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 will be removed, and the catheter 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. An x-ray will be done to check the catheter's location.

Waiting room:

This room is where you and your family can wait until your child is ready for visitors after the procedure. Your child's caregiver can then find you to let you know how the procedure went. If you or your family leave the hospital, leave a phone number where you can be reached.

Contact a caregiver if

• Your child has a fever.
  
  
• You have questions or concerns about having the catheter put in your child.

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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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