Tunneled Central Lines Child

• 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 will be up to three small catheter 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.

Why does my child need a tunneled central line?

Tunneled central lines are used for long term medicines and treatments. They may stay in for several months. Catheters are often put in if your child has to get IV medicines at home. The following are medicines and treatments your child may have through a tunneled central line:

• Blood.
  
  
• Chemotherapy: This is medicine to treat cancer.
  
  
• Antibiotics: This is medicine to treat an infection.
  
  
• Total Parenteral Nutrition (TPN): This is a special liquid food that goes into your child's vein.
  
  
• Blood sample collection.

What are the risks of having a tunneled central line?

• 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.

How do I care for my child's tunneled central line?

• Hand washing: Always wash your hands with soap and water before touching the central line or the area around it. Hand washing helps prevent infection. Ask caregivers for information about hand hygiene. Do not touch or handle the catheter unless you need to give your child medicine or a treatment, or to care for the central line. Teach your child to avoid touching or handling the catheter. Wash your hands and put on new medical gloves before touching or handling the catheter.
  
  
• The place where the catheter is inserted must be checked daily for signs of infection and other problems: The place where the catheter is inserted must be checked daily for signs of infection and other problems. Your child's 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 medicine 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.
  
  
• The central line may need to be flushed: The central line may need to be flushed. This is when you push a small amount of fluid through the central line using a syringe. This liquid may be saline (sterile salt water), heparin (blood thinning medicine), or both. Flushing is done to help prevent the catheter from getting blocked. Flushing is also done to help prevent medicines from mixing with each other in the tubing. Ask caregivers what to use if you need to flush the central line, and ask them to show you how to flush it correctly.
  
  
• Activity guidelines: Do not let your child go swimming. Swimming exposes the central line to germs that can cause infection. It is better to take a shower than a bath when there is a central line in place. Your child should not use the arm with the catheter to lift or push things. Teach your child not to pull on the catheter tails, and to avoid getting them caught on things like clothing. Ask caregivers about other activity guidelines with a central line.

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.

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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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