Care of your tunnelled central line

Information for patients

This leaflet answers common questions about caring for your tunnelled central line. If you would like any further information or have any particular worries, please do not hesitate to contact your specialist nurse or doctor.

What is a tunnelled central line?

A tunnelled central line is a soft, hollow tube that is placed into a large vein leading into the heart and comes out through a small opening in the chest area. This opening is called ‘exit site’. There is also an entry site either in your neck or under your collar bone. This is a small opening which is stitched with dissolvable stitches.

There is a cuff on the line a few centimetres above the exit site. This holds the line in position and helps prevent infection. There is a plastic clamp on the line which must be closed when the line is not in use. At the end of the line there is a cap.

How long will I be in the department?

You will need to be prepared to be in Vascular Access Unit for at least 2-3 hours for your line insertion and your recovery time. Some patients will be admitted to hospital to start treatment as soon as the line is inserted, other patients will be discharged out into the community providing there are no complications.

What to do when you arrive

When you arrive at the department, please report to our administrator at the reception area.

Staff you are likely to meet

You are likely to meet one of the Consultants, the Vascular Access Specialist Nurses and Healthcare Support workers whilst you are in Vascular Access Unit.

Preparation for procedure/examination

You will need to have recent blood results available prior to the procedure , such as full blood count and clotting. Your Specialist Nurses will arrange this for you.

If you are taking any blood thinners, you will need to have advice from them as to when you may need to stop them.

Please contact us in advance of your procedure/examination on 01223 596020 if you:

• Have additional requirements that may require a longer appointment
• Require a specific appointment time due to taking time sensitive medication (e.g. insulin, medicines for Parkinson’s disease).
• Are claustrophobic,
• Are pregnant,
• Require hospital transport
• Are unable to lie flat
• Have mobility issues

Benefits

The tunnelled line can be used to give you fluids, blood products, medicines and take blood samples.

What are the risks with my tunneled central line?

Infection

If you have a temperature above 37.5 degrees, fever, chills or feel generally unwell it could mean that you have an infection. Please contact your team immediately if this happens.

Signs of a blood clot

Pain, swelling or discomfort in your neck or arm on the side of the catheter, could be signs of a clot. It is usual for the first couple of days following insertion to feel discomfort. This is not a medical emergency but you can get advice from your specialist nurses.

Blocked line

If the line becomes blocked, then it may be difficult to aspirate blood or to inject through the line. In most cases, the line should not be used until the problem has been dealt with. Special clot-busting drugs can usually help- please contact your specialist team

Line falls out

In the unlikely event that this occurs, you should lie down and immediately apply pressure to the site to stop any bleeding. You must get help immediately.

CONTACT YOUR SPECIALIST TEAMS IMMEDIATELY IF YOU HAVE ANY OF THE ABOVE SYMPTOMS.

What happens if the tunnelled line breaks?

If your line cracks or breaks, don’t worry. Clamp, pinch or tie your catheter immediately above the break. Cover with a dressing and contact your specialist teams as soon as possible. You will have to return to hospital to get it repaired or replaced.

What will happen on the day of my procedure/examination?

On the day, the Consultant or one of the Specialist Nurses in Vascular Access Unit will discuss with you the procedure and will answer your questions. When you are satisfied, you will be required to sign a consent form. You will need to change into a hospital gown and remove all jewellery.

If you decide to have conscious sedation, you will need to have a cannula inserted. A responsible adult will need to accompany you after the procedure and you will need to make arrangements for travelling, as you will not be fit to drive for 24 hours.

During the procedure, you will be lying flat on the theatre bed. You will have local anaesthetic to make the procedure comfortable for you.

A Radiographer will enter the room when the line is about to be inserted so we can confirm the position with an Xray machine.

Your tunnelled line will be safe to use straight after it is inserted.

Accessibility requirements

If you require support for your appointment, e.g. if you find it hard to hear, see or be understood by others, please let the receptionist or healthcare professional know on arrival or contact us by email: cuh.accessibility@nhs.net or telephone: 01223 256998.

Pregnancy status

We have a legal responsibility to enquire if you are pregnant. Any patient aged between 12-55 years will be asked if there is a possibility they could be pregnant. This is important for us to know before you have your examination involving ionising radiation/before you enter the strong magnetic field of the scanner.

You can discuss this with a healthcare professional in private if you wish.

Medication

Bring all of your medicines (including inhalers, injections, creams, eye drops or patches) and a current repeat prescription from your GP

Can I bring someone with me?

Those accompanying you will be required to stay out of the room during the procedure and remain in the waiting area.

Childcare whilst in department

Staff are unable to look after or supervise children whilst your procedure/examination is taking place. Please make alternative arrangements for the care of your children whilst you attend for your procedure/examination. If you attend an appointment with children with no one to look after them whilst you have your examination/procedure, then your appointment will unfortunately have to be cancelled and rescheduled.

Personal belongings

The department can keep small items in a safe whilst you are having the procedure andwill be returned to you afterwards. Alternatively, you may have your belongings with you in the room kept in a dedicated tray for the patients’ belongings.

What happens after my procedure/examination?

Once the line has been placed it is important to keep it clean and dry. This includes the entry site, the exit site and the bungs of the line. A special glue is applied to the insertion and exit site at the time of insertion. A transparent dressing will cover the exit site while the stitch is still in place. If the wound appears clean and dry the line needs to be re dressed each week. If bleeding occurs and is bigger than a 5 pence piece the dressing will need to be changed as soon as possible.

At 7 days a chlorhexidine disc will be put around your catheter at the exit site. This stays in place for as long as you have stitches attached to your skin. It needs to be changed every 7 days when you have your dressing changes done by your nursing team.a

After about 3-4 weeks, when the wound has healed, the stich needs to be removed by a nurse. A dressing will no longer be needed, but the line must remain looped and secured with tape.

What do I need to know about the use of my tunnelled line?

Regular flushing of your line is necessary to prevent the line from becoming blocked. This should be done once a week. You may get this done at the hospital or district nurses will be contacted. This is arranged by your specialist nurse.

The end of the line must be cleaned with a chlorhexidine wipe before it is used.

No smaller than a 10 ml syringe must be used to put fluids in your line and each end must be flushed separately if you have more than one. The line should be “locked” with 2mls of Hepsal if it is not being used for more than 24 hours.

The bung should be changed each week. Remember to check daily that the bung is attached and the clamps are closed.

Please note dressing changes, line flushes and bung changes are a sterile procedure. if you experience a cold and shivery feeling during or after your line flush contact your emergency numbers.

Possible side effects and additional aftercare

Will it be painful afterwards?

Once the local anaesthetic wears off you may find the procedure site tender and uncomfortable – this is normal and should only last a day or two. It is fine to take simple painkillers such as paracetamol if required.

Can I have a bath/shower?

You can shower with a line in, but you need to keep the line as dry as possible. The line, exit site or bungs must not be submerged because of the risk of infection.

Can I lead a normal social life?

Having a central venous catheter should not interfere with your social life. Please talk to your specialist team before planning a trip abroad.

Can I play sports and swim?

Sports and exercise that include vigorous activity should be avoided because the catheter may become dislodged. Make sure the catheter is secure. Do not swim with the catheter in place because of the risk of infection.

How is the tunnelled line removed when it is no longer needed?

The tunnelled line is removed by making a small cut and releasing the cuff which holds the line in place. A local anaesthetic is given to numb the area around the cuff before it is removed. Dissolvable stitches are used to close the wound. It will be covered by a dressing which is removed after a couple of days. You will need to have an appointment made by your specialist team and come back into hospital. You will need to have blood samples taken and stop blood thinning medication before removal. This will be arranged by your specialist team.

Alternatives

Your team has requested the tunnelled line for your treatment, but if you would like to have information about other types of lines that may be appropriate, the Vascular Access Unit team can discuss these with you.

Contacts/Further information

Vascular Access Unit

Outpatients

Radiology, Level 4

Tel: 01223 596020

Vascular Access Unit is located on Level 4, at the Outpatient end of the hospital.

On Level 3, next to the Ultrasound Department, you will find the lift (number 4) and stairs which will bring you up to Vascular Access Unit.

Nearest bus stop - Outpatient Bus Stop or main Addenbrooke’s bus station

Facilities available

All gender toilets and disabled toilet is available in Vascular Access Unit.

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Question, concern or complaint?

Firstly speak to your nurse, doctor or other staff member as soon as you can so they can do their best to put things right straightaway.

If you don’t feel able to speak directly to the people caring for you, contact the patient advice and liaison service (PALS). Please call 01223 216756 9am to 4pm Monday to Friday, via email at cuh.pals@nhs.net, or via a form available via link on the CUH PALS webpage.

PALS is open every weekday, and you can leave a message in the evenings and weekends.

MyChart

We would encourage you to sign up for MyChart. This is the electronic patient portal at Cambridge University Hospitals that enables patients to securely access parts of their health record held within the hospital’s electronic patient record system (Epic). It is available via your home computer or mobile device

More information is available on My Chart.