Central lines

A central line is a long, thin, hollow tube that can be used to give chemotherapy or other treatments. Central lines are also called skin-tunnelled central venous catheters. Or you may hear them called by brand names, such as Hickman^® or Groshong^® lines.

A doctor or nurse will put the central line in under the skin of the chest and into a vein close by. One end of the line goes into a large vein just above the heart. The other end comes out of the chest.

The line is usually sealed with a special cap or bung. Your doctor or nurse can attach a drip or syringe to the line to give you medication. There may be a clamp to keep the line closed when it is not being used.

Sometimes, the central line is made up of 2 or 3 fine tubes. These are joined as one tube inside the body and divide into 2 or 3 lines outside the body. This allows you to have different treatments at the same time.

A specialist nurse or doctor will put your central line in at the hospital. You will usually have a local anaesthetic for this, but sometimes a general anaesthetic is used. If you have a local anaesthetic, you may also have sedation to help you relax.

Before the procedure, the doctor or nurse may use a small ultrasound machine to help them find a suitable vein in your neck. Then they clean the skin with an antiseptic solution in the area where the line will be put in.

They numb this area with a local anaesthetic. You should not feel any pain when they are putting the tube in, but you may feel sore for a few days afterwards.

When the area is completely numb, the doctor or nurse will make a small cut in the skin near the collarbone. This is called the insertion site. They will gently thread the tip of the line into a large vein, towards the heart.

They then tunnel the other end of the line under the skin to where it comes out of the body. This is known as the exit site. You will have a chest x-ray to make sure the line is in the right place. The diagram below shows the positions of the central line.

The position of the exit site will vary. You can ask your specialist doctor or nurse to show you where on the chest the exit site is likely to be.

When the line has been put in, you will have dressings covering the insertion and exit sites. For a few days afterwards, you may have some pain or discomfort where it has been tunnelled under the skin. You can ask your doctor or nurse which painkillers you should take to help with this.

When the central line is not being used, there is a small risk of it becoming blocked. To stop this from happening, a nurse will flush a small amount of fluid into the line using a syringe. This is usually done once a week.

To reduce the risk of infection:

• Caps or bungs should be changed every week.
• The exit site needs to be cleaned once a week. If you have a dressing on the site, it will also need to be changed once a week.
• Sometimes, a special dressing, such as an antibiotic disc, may be put over the exit site.

The nurses can teach you how to flush the line and change the dressings. They can also show a family member, partner or friend how to do this.

This needs to be done in a sterile way to avoid infections. Only people who have been trained will be able do this. If you prefer, a district nurse can do it for you at home.

When you are at home, it is safe for you to have a shower or bath with your central line.

You can place your line in a plastic bag and tape it to your skin so that the line does not get wet. Or your nurse can give you waterproof dressings to stop the line getting wet. You should keep the exit site out of the water in a bath.

Swimming should usually be avoided because there is a risk of infection. Talk to your doctor if you want to do other sports or activities. This is because there is a risk that your central line could become dislodged. Your doctor or nurse can give you information about the exercises you can do.

When you do not need the central line anymore, a doctor or specialist will take it out. This is usually done in the outpatient department and takes about 30 minutes. You will not usually need a general anaesthetic.

Once you are lying down comfortably, the skin over your chest will be cleaned with antiseptic. The doctor or nurse will then numb the area around the cuff with local anaesthetic. They will make a small cut to release the cuff, then slowly remove the line. You might find this uncomfortable, but it should not be painful.

Once the line is out, your nurse or doctor will put a dressing over the exit site. You will be asked to stay lying down for about 10 minutes until they are sure there is no bleeding.