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Tunneled Central Lines in Children

WHAT YOU NEED TO KNOW:

What is a tunneled central line?

A tunneled central line is a type of long-term IV catheter. You can see under your skin before it enters a vein near your heart. Surgery will be used to place the catheter. Before you leave the hospital, you will be shown how to use, flush, and care for your central line. You will also be taught how to prevent an infection.

Why may my child need a tunneled central line?

  • Your child needs long-term IV therapy. A catheter has one or more lumens (openings). Healthcare providers can give your child medicine, take blood, or do other tests through these openings. Tunneled central lines can stay in place longer than some other types of IV catheters. Healthcare providers can give your child medicine such as IV antibiotics or chemotherapy for several months. He or she can also get TPN (liquid food) and IV liquids through a tunneled central line.
  • Your child's veins need to be protected. Healthcare providers may have a hard time placing an IV if your child's veins are small or damaged. He or she may also need medicine that could harm skin or small veins. Your child's skin and veins are protected when the medicine goes through the catheter instead.
  • Your child often needs blood transfusions or blood drawn for tests. He or she can receive blood through the catheter. Healthcare providers can also take blood samples. Your child will not have a needle put into a vein each time. Healthcare providers will use the catheter instead.

What do I need to remember about the central line?

The following can help prevent an infection or other problems:

  • Clean and change the catheter parts as often as directed. You will be shown how to clean the caps, hubs, and injection ports. Always clean the parts before you attach and after you remove tubing from your child's catheter. Use a new alcohol pad for each part you clean. Ask his or her healthcare provider how often to change the caps and the medicine tubing.
  • Flush the catheter before and after you use it. Your child's healthcare provider may give you syringes filled with saline (salt water) or heparin (a blood thinner) to flush the catheter. Stop if it is difficult to push the plunger. Do not force the saline or heparin into your catheter. This could damage the catheter or your child's vein. The force could also cause a blood clot to move into his or her blood. Stop when about 1 milliliter (mL) is left in the syringe. This will keep any air bubbles in the syringe.
  • Clamp the catheter as needed. You may need to clamp the catheter at certain times, such as when the caps and tubing are being changed. The catheter is clamped to help prevent air from getting in.
  • Loop and secure extra tubing. Loosely loop the tubing. Secure it to your child's arm with medical tape. This will help prevent the catheter from being pulled out by accident. Teach your child not to touch, play with, or pull on the catheter. Tell him or her why the catheter is being used. Explain that it needs to stay secured to his or her arm to keep it clean and protected.
  • Ask about activity. Your child's healthcare provider will tell you which activities are safe for him or her. Your child may not be able to play contact sports until the catheter is removed.

What can I do to prevent an infection?

The area around the catheter may get infected, or your child may get an infection in his or her bloodstream. A bloodstream infection is called a central line-associated bloodstream infection (CLABSI). A CLABSI is caused by bacteria getting into the bloodstream through the catheter. This can lead to severe illness. The following are ways you can help prevent a CLABSI:

  • Wash your hands and your child's hands often. Use soap or an alcohol-based hand rub. Clean your hands before and after you touch the catheter or the catheter site. Remind everyone who cares for your child's catheter to wash their hands.
    Handwashing
  • Limit contact with the catheter. Do not touch or handle the catheter unless you need to care for it. Do not pull, push on, or move the catheter when you clean your skin or change the dressing. Wear clean medical gloves when you touch your child's catheter or change the dressings.
  • Keep the area covered and dry. Keep a sterile dressing over the catheter site. Wrap the insertion site with plastic and seal it with medical tape before your child bathes. Have him or her take showers instead of baths. Do not let your child swim or soak in a hot tub.

Call your local emergency number (911 in the US) for any of the following:

  • Your child has pain in his or her arm, neck, shoulder, or chest.
  • Your child coughs up blood.
  • Your child has chest pain or trouble breathing.

When should I seek immediate care?

  • The catheter site turns cold, changes color, or your child cannot feel it.
  • You see blisters on your child's skin around where the catheter enters it.

When should I call my child's doctor?

  • Your child has a fever.
  • The catheter site is red, warm, painful, or is oozing fluid.
  • You see blood on the bandage and the amount is increasing.
  • The veins in your child's neck or chest bulge.
  • You cannot flush your child's catheter, or he or she feels pain when you flush the catheter.
  • You see that the catheter is getting shorter, or it falls out.
  • You see a hole or a crack in the catheter. Clamp the catheter above the damage before you call your child's doctor.
  • You have questions about how to care for the catheter.

Care Agreement

You have the right to help plan your child's care. Learn about your child's health condition and how it may be treated. Discuss treatment options with your child's healthcare providers to decide what care you want for your child. 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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