Skin tunnelled central venous catheters - Northumbria Healthcare 226542 - Skin Tunnelled Catheters leaflet A5.qxp 07/06/2018 10:34 Page 1 ...
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226542 - Skin Tunnelled Catheters leaflet A5.qxp 07/06/2018 10:34 Page 1
Northumbria Healthcare
NHS Foundation Trust
Skin tunnelled central
venous catheters
Issued by the infection control department
226542 - Skin Tunnelled Catheters leaflet A5.qxp 07/06/2018 10:34 Page 2
Introduction
It has been recommended that you have a skin tunnelled central
venous catheter (CVC). These are often referred to as Hickman®
or Groshong® lines.
This leaflet aims to provide information about the procedure and
about the future care of your skin tunnelled CVC.
What is a skin tunnelled CVC?
Skin tunnelled CVC’s (also called central lines) are long, hollow
tubes made from silicone rubber. The tube is usually put into a vein
at the base of your neck or below your collar bone and then
tunnelled under the skin of your chest. One end of the line ends up
in a large vein just above your heart. The other end comes out of
your chest and is called a lumen. It is usually sealed with a special
cap or bung and can be attached to a drip or syringe containing
your medication. There may be a clamp to keep the line closed
when it’s not being used.
Why do I need a central line?
A tunnelled central line or CVC is usually recommended for
patients who need certain types of medicines or treatments which
may irritate or damage smaller veins. They are also used for
treatments that are given over a long period of time.
The reasons you need a central line should have been discussed
with you by your doctors and nurses. You can decide not to have
this procedure or to wait until you have had time to think about it,
however this may delay your treatment.
2
226542 - Skin Tunnelled Catheters leaflet A5.qxp 07/06/2018 10:34 Page 3
Figure 1 shows the position of a skin tunnelled central line
'
"
" Your
' nurse/doctor/practitioner
' ' ' ' ' ' will' discuss
' ''the insertion procedure,
alternatives and potential problems with you. You will be offered an
opportunity to discuss any issues prior to the central line insertion
J ' ' ' ' ' ' ' ' '
' ' when the' person performing
' ' the procedure takes
' ' written 'consent
' ' ' ' ' ' ' ' ' ' ' ' ' '
' from you.
' ' ' ' '
' ' ''
How do I prepare for the central line insertion
!
procedure?
' '' ' ' ' ' ' ' '
' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' '
• You will usually need to have a blood test to measure full blood
' ' ' ' ' ' ' ' ' ' ' ' '
' count and
' ' clotting
' before
' the procedure. Your doctor or clinic
nurse specialist will arrange it when they recommend a central
'
line.
' ' ' ' ' ' ' ' ' ' ' ' ' ' '
• ' If you' are' currently receiving chemotherapy, a blood test is
' ' ' ' ' ' ' ' ' ' ' ' ' '
needed close to the time of the procedure. If you are not
' ' ' ' '
' currently on
' ' chemotherapy ' a blood test ' within 'eight
' weeks ' of the
'
' ' ' ' ' '
'procedure' is' fine.' ' ' ' ' ' ' ' '
• Please ' 'let us' know ' if 'you
' are' taking' any antiplatelet
' ' medicines
' ''
' for example, Aspirin, Clopidogrel or any medicines that thin the
' '
blood
'
for
'
example, ' '
Warfarin,
'
Rivaroxaban,
' '
as these
' ' '
may
'
need to
' '
be stopped temporarily before the procedure.
''
'
' ' ' ' ' ' ' ' '3 ' ' ' ' ' '
' ' ' ' ' ' ' ' ' ' ' '
' ' ' ' ' ' ' ' ' ' ' ' ' ' '
' ' ' ' '
'226542 - Skin Tunnelled Catheters leaflet A5.qxp 07/06/2018 10:34 Page 4
• Take your other medicines as normal, unless your doctor or
nurse tells you not to.
• You can eat and drink before the procedure as it does not
normally require sedation. However if you have extreme anxiety
and have discussed sedation with your doctor or nurse, you will
need to stop eating six hours before, and drinking two hours
before the procedure.
• Please arrive 30 minutes before your appointment to allow
enough time for preparation.
• You will need a responsible adult to take you home by private
transport. We do not recommend that you use public transport
as it is unsafe if you feel unwell.
You can ask your doctor or nurse to show you where, on your
chest, the exit site is likely to be.
What happens when I have the central line inserted?
The central line will be inserted in an operating theatre and the
procedure should take about 30 minutes. It is not an operation but
the person inserting your catheter will treat it as a very clean
procedure. They will wear a sterile gown, gloves, mask and
prepare sterile equipment. This is done under a local anaesthetic.
Your neck will be checked for a suitable vein using an ultrasound
machine. The area where the central line will be put in is then
cleaned with an antiseptic solution. Local anaesthetic is used to
numb the area. This usually stings for a few seconds, but otherwise
you shouldn't feel any pain when the line is being put in.
A small cut is made in the skin near your collarbone. This is called
the insertion site. The tip of the central line is threaded into a large
vein, towards the heart. The other end of the line is then tunnelled
away from the insertion site under the skin to reach the exit site
4226542 - Skin Tunnelled Catheters leaflet A5.qxp 07/06/2018 10:34 Page 5
where it comes out of your skin. The exit site is usually next to the
breastbone.
When the central line has been inserted, you will have dressings
covering both the insertion and exit sites. For a day or two after
you may have some mild discomfort where it’s been tunnelled
under the skin. This can be treated with simple painkillers such as
Paracetamol. A few people are aware of a ‘lump’ in their throat
when they swallow but this sensation doesn’t usually persist.
After the central line has been inserted you will have a chest x-ray
to make sure it is in the right place. Once the x-ray has been
checked you may begin to receive your treatment. If you are not
due to receive treatment that day you will be able to go home
shortly after the procedure.
Is it a painful procedure?
The local anaesthetic does sting as it goes in and the tunnelling
process can feel odd, but is not usually painful. The vast majority of
patients have told us that the procedure was better than expected.
What stops the central line from falling out?
There is a small cuff around the central line. It can be felt under the
skin, just beneath the exit site. The tissue under the skin grows
around this cuff in about three weeks and holds the line safely in
place.
Until this happens, you will have a stitch holding the line in place.
These stitches can usually be removed after three weeks. Before
you go home, the team looking after you will tell you who will
remove these stitches.
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Benefits and alternatives
A central line is a reliable way for nurses and doctors to give you
intravenous medicines (medicines that need to go directly into a
vein), or to take blood samples. It means you can avoid needle
puncture every time you have treatment, which can be
uncomfortable and stressful. Some medications need to be given
into a large vein rather than a small vein in the hand or arm. A
central line is recommended for patients who regularly have
chemotherapy, long-term antibiotics and infusions. It can remain in
place for a long period of time so it can be used throughout your
treatment.
It is possible for some people to have a different type of central
venous catheter inserted. If you would like more information,
please discuss this with your doctor/nurse /practitioner.
Potential risks
Serious risks and complications of having a central line are very
rare. However, as with any procedure, some risks or complications
may occur.
Infection: the procedure is carried out using a full sterile technique
but there are still risks of the catheter becoming infected. This may
be local infection at the skin or a more general bloodstream
infection. It is likely that this infection would be treated with
antibiotics but occasionally the central line may have to be
removed.
Blockage: the central line can sometimes become blocked.
Regular flushing helps prevent this. If it does become blocked and
it is not possible to flush it, the central line may have to be
removed.
6226542 - Skin Tunnelled Catheters leaflet A5.qxp 07/06/2018 10:34 Page 7
Local bruising or pain at the site of insertion: this usually
settles within a few days. You may require some simple pain killers
such as Paracetamol.
Poor position of the central line: The tip of the central line should
sit in one end of the major vein near to the heart. However this
does not always happen and the central line may need to be
moved or replaced so that it is in the correct position.
Lung puncture: This is a very rare complication and can happen
in 1 in every 1000 patients. If this occurred, we may have to keep
you in hospital for a few days until the lung had healed.
Accidental removal: In spite of the cuff or the stitches this can
occasionally occur.
Split Line: It is very important to prevent the central line from
getting damaged. In the unlikely event that the central line
develops a split or a break it will usually be removed, although
occasionally it is possible to repair it using special equipment.
Please ask your doctor/nurse/practitioner if you have any concerns
or would like any further information about potential risks.
Caring for your central line
If you are in hospital
Nursing staff will look after your central line. This involves:
• Removing the stitches in your neck 7 days after insertion and
around the central line 3 weeks after insertion.
• Cleaning the insertion site and central line with antiseptic and
applying a clean dressing, weekly until the exit site is well
healed.
7226542 - Skin Tunnelled Catheters leaflet A5.qxp 07/06/2018 10:34 Page 8
• Replacing the bung at the end of the lumen with a new bung
every 7 days or more frequently depending upon the treatment
you are having.
• Flushing the lumen with salt water solution before and after each
use. This is required to prevent the central line becoming
blocked.
If you are at home
When your central line is not being used it should be flushed with
salt water solution every week. The bung should also be replaced
and a new bung cover applied at the same time. This can be
carried out by;
• Nursing staff on the day unit.
• Nursing staff at your local GP practice/health centre.
• District nurses who can visit you in your home if you are unable
to get to your local health centre.
Or alternatively
• You or a family member/friend could be taught to care for your
central line independently.
Please discuss the above with you nurse specialist on the ward/
day unit.
Before you go home you will have been supplied with equipment
and instructions which will enable you to care for your central line
correctly.
Dressing changes
The dressing covering your central line should be checked every
day for signs of bleeding and oozing. If it is wet or soiled it should
be changed immediately.
8226542 - Skin Tunnelled Catheters leaflet A5.qxp 07/06/2018 10:34 Page 9
Hand hygiene
Any person caring for your central line including yourself, should
wash their hands and put on gloves prior to handling it.
Can I bathe/shower?
As a general rule we encourage people with lines to take a shower.
This is preferable to submerging your line and exit site in bathwater
because of infection risk.
If the dressing is loose after your bath/shower, it should be
replaced. Your nurse will show you how to do this. If your central
line is being managed by a district nurse you should contact them
on the number they have given you.
Can I lead a normal life?
Having a central line in place should not interfere with your social
life. However, your chemotherapy drugs may temporarily restrict
certain social activities either immediately after treatment or if your
‘blood counts’ are low. Your nurse or doctor will give you more
specific information. Please talk to your doctor before planning a
trip abroad with a central line in place.
Can I play sports and swim?
Sports and exercise that include vigorous activity should be
avoided. There is a small risk that your central line could become
dislodged because of excessive upper-body movement. There are
many other pursuits which are acceptable. If in doubt ask your
nurse or doctor. We advise you not to go swimming because of the
risk of infection. If you have any questions about any aspect of
your central line position or appearance, do not hesitate to contact
either your ward or the procedure team nurses.
9226542 - Skin Tunnelled Catheters leaflet A5.qxp 07/06/2018 10:34 Page 10
When and how will my central line be removed?
When you don’t need the central line anymore, it will be taken out.
A doctor/specialist nurse/practitioner will do this for you. It’s usually
done in the operating theatre and takes about 30 minutes. You
won't usually need a general anaesthetic.
The procedure involves making a small cut over the cuff and then
withdrawing the line. It is done under local anaesthetic. You might
find this uncomfortable, but it shouldn't be painful.
Any problems?
If you experience a cold and shivery attack during or after flushing
your line, you must contact the advice number provided on page
11, as this could indicate that the line is infected.
You should also contact the hospital straight away if:
• You experience pain, redness or swelling in your arm or neck on
the same side of the body as your line.
• The cuff or line has moved.
• You feel breathless.
• Your line becomes damaged or develops a leak.
If the central line breaks, whether bleeding does or does not occur,
do not panic. Using a clean towel apply sufficient pressure at the
site, and make sure it remains covered. You should then go to your
nearest accident and emergency department immediately.
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Additional information
Name of consultant managing your care:
..........................……………………………………………............……
Discharging ward/department:
..........................……………………………………………............……
Hospital: ……………………………………………………............……
Contact numbers for advice
Ward contact: …………………………………….........………………..
District nurses contact: …………….........……………………………..
Oncology day unit: ……………............………………………………..
Fig 1: image printed with kind permissions of Macmillan Cancer Support
11226542 - Skin Tunnelled Catheters leaflet A5.qxp 07/06/2018 10:34 Page 12
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