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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 IV catheter. A catheter is a flexible tube used to give treatments and to take blood. A tunneled central line is a catheter that you can see under your child's skin before it enters a large vein near his heart.
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. Your child 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. Your child may also need medicine that could harm his 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: Your child 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.
How can I prevent catheter-associated infections?
The area around your child's catheter may get infected, or he may get an infection in his bloodstream. A catheter-associated infection is caused by bacteria getting into your child's bloodstream through his catheter. Infections from catheters can lead to severe illness. The following are ways you can help prevent an infection:
- Wash your hands: Use soap or an alcohol-based hand rub to clean your hands. Clean your hands before and after you touch the catheter or the catheter site. Ask your child's healthcare provider for information on how to wash your hands. Remind anyone who cares for your child's catheter to wash their hands.
- Wear medical gloves: Wear clean medical gloves when you touch your child's catheter or change the bandages.
- Limit contact: Do not touch or handle your child's catheter unless you need to care for it. Do not pull, push on, or move the catheter when you clean your child's skin or change the bandage.
- Clean your child's skin: Clean the skin around your child's catheter every day and just before you change the bandage. Ask your child's healthcare provider what to use to clean your child's skin.
- Check for infection: Check your child's skin every day for signs of infection, such as redness, swelling, and oozing. Contact your child's healthcare provider if you see these signs.
- Cover the area: Keep a sterile bandage over the catheter site for as long as your child's healthcare provider directs. Your child may no longer need a bandage after his catheter site heals. Change the bandage as directed or when it is loose, wet, dirty, or falls off. Change your child's bandage in a place away from open windows, heating ducts, and fans. Be sure it is well-lit, clean, and free of dust. Clean the skin under the bandage with the solution your child's healthcare provider suggests. Let the area dry before you put on the new bandage.
- Keep the area dry: Do not let your child's catheter or catheter site get wet. Wrap your child's arm with plastic and seal with medical tape before he bathes. Ask if your child should take showers instead of baths.
How should I care for my child's tunneled central line?
Your child's healthcare provider may want you to do the following to reduce your child's risk of infection or complications:
- Clean the catheter parts: Clean the caps, hubs, and injection ports before you attach and after you remove tubing from your child's catheter. Open the package that contains the new alcohol pad. Put on new medical gloves. Use a new alcohol pad for each part you clean. Throw away used alcohol pads.
- Flush your child's catheter: Your child's healthcare provider may give you syringes filled with saline (salt water) or heparin (a blood thinner) to flush your child's catheter.
- Attach the syringe that contains the flushing solution to the end of the catheter tubing. Slowly push the fluid out of the syringe and into the catheter. Throw the syringe away. Clean the end of the catheter or cap with a new alcohol pad.
- Do not force the fluid. Force could damage the catheter, or release a blood clot from the end of the catheter. Straighten any kinks in the tubing. Contact your child's healthcare provider if it is still hard to push fluid into the catheter.
- Change the caps and medicine tubing: Your child may need extra tubing to get medicine. Ask your child's healthcare provider how often to change the caps and the medicine tubing.
- Clamp the catheter: You may need to clamp your child's catheter at certain times, such as when the tubing is being changed. The catheter is clamped to help prevent air from getting in.
- Loop extra tubing: Loosely loop the tubing together. Secure it to your child's body with medical tape. This will help prevent the catheter from being pulled out by accident.
What are the risks of a tunneled central line?
- One or more attempts may be needed to place the catheter. The vein where your child's catheter is placed may become irritated, and his skin may get red, painful, and blister. When the catheter is put in, your child's vein may tear, or the catheter may injure a nerve. Your child's catheter may get blocked, and healthcare providers may need to remove or replace it.
- The catheter may break, bend, or move out of place. The IV medicine may leak outside your child's vein and cause pain, swelling, or blisters. Your child can have bleeding, an allergy to heparin, or heparin-induced thrombocytopenia (HIT). HIT is a low number of blood platelets, which increases the risk of bleeding. Your child may get a blood clot in his arm. This can cause pain and swelling, and can stop blood from flowing where it needs to go in your child's body. The blood clot may break loose and travel to your child's lungs or brain. A blood clot in your child's lungs can cause chest pain and trouble breathing. A blood clot in your child's brain can cause a stroke. These problems can be life-threatening.
- If your child does not have a catheter placed, he may need to get multiple needle sticks. It may be hard for healthcare providers to give your child the treatment that he needs. Your child's condition may get worse, or he may die. Contact your child's healthcare provider if you are worried or have questions about a tunneled central line.
When should I contact my child's healthcare provider ?
Contact your child's healthcare provider if:
- Your child has a fever.
- The catheter site is red, warm, painful, or oozing fluid.
- You see blood on your child's bandage and the amount is increasing.
- The veins in your child's neck or chest bulge.
- You cannot flush your child's catheter, or your child feels pain when you flush his catheter.
- You see that the catheter is getting shorter, or it falls out. Put pressure over the site with a clean towel.
- You see a hole or a crack in your child's catheter. Clamp the catheter above the damage before you contact your child's healthcare provider.
- You have questions about how to care for your child's catheter.
- You run out of supplies to care for your child's skin or catheter.
When should I seek immediate care?
Seek care immediately or call 911 if:
- Your child has pain in his arm, neck, shoulder, or chest.
- The catheter site turns cold, changes color, or your child tells you that he cannot feel it.
- You see blisters on your child's skin around where the catheter enters it.
- Your child has chest pain or trouble breathing that is getting worse over time.
Care AgreementYou 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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