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A tunneled central line (sometimes known as a Powerline®, Hickman®, or Broviac® catheter) is a central venous catheter that is tunneled under the skin. It is usually inserted into a vein under the collarbone (subclavian vein) or in the neck (jugular vein) and guided through the vein until it reaches the correct place near the heart. The end of the catheter comes out through an opening in the upper part of the chest. In rare cases, the femoral or another vein may be used.
A tunneled central line allows medicines, nutrition, blood products, and fluids to be given into a large vein. Blood samples can also be taken.
One end of the catheter stays outside the skin and has one or two tubes called lumens. Each lumen has a cap called a needleless connector placed on the end. The connectors keep the lumens from leaking and keep air and bacteria out. The connectors allow medicines and fluids to be given without needle sticks.
A dressing is worn over the area to protect against infection. The dressing also helps keep the catheter in place. The catheter also has a Dacron® cuff around the tubing just under the skin on the chest to hold it in place and act as a barrier to infection. The cuff may be felt as a small bump under the skin.
Tunneling the catheter under the skin helps to lower the chance of infection. However, because part of the catheter stays outside the skin, there is a chance for bacteria to enter. With good care, the catheter can stay in place for months to years before it needs to be removed. It is important to follow all instructions to prevent infection and keep the line working properly.
Placement of a tunneled central line is a common procedure during cancer treatment and has important benefits for patients and families. However, there are always risks involved with anesthesia and surgery. The main risks during insertion include bleeding, puncture of a lung or blood vessel, blood clots, irregular heartbeat, nerve injury, and infection. After line placement, blood clots, movement of the catheter out of position, and infection are the most common complications. Serious complications are rare, but they do occur. Be sure to ask questions and follow all instructions given by the care team.
Children will receive general anesthesia for central line placement. They will not feel pain or be aware during the procedure. Patients will be given NPO instructions for limiting food and drink before the procedure. It is very important to follow these guidelines. The total time for the procedure is usually about 1-2 hours with anesthesia and recovery.
A nurse will teach families how to care for the central line. Lines must be flushed daily with heparin. Heparin is a medicine that keeps the blood from clotting and blocking the line. A dressing is worn over the area to prevent infection and keep the catheter in place. The dressing should be changed once a week or if it gets wet, dirty, or comes off. It is important to keep the dressing from getting wet during bathing.
The area will be sore for a few days. There will be a few stitches where the tube goes in and out. There may be small amounts of blood on the dressing or bruising in the area. It may feel like the line is pulling on the outside of the skin. Complete healing takes 2-4 weeks.
Be careful when picking a child up under the arm on the same side as the central line. This may cause discomfort.
Medications may be given with a syringe or an IV bag. Let a nurse know if you have any pain or discomfort while receiving your medications.
Follow all care instructions to keep the line working properly and to prevent infection. Always wash your hands before touching the catheter. The needleless connector should be cleaned before each connection to the line.
Avoid activities that could damage the catheter such as contact sports or rough play. You should not swim with a PICC line because it might cause infection.
Make sure the line is secured, and keep a clean, dry dressing over the site at all times. Watch for signs of damage to the line.
A Central Line Associated Blood Stream Infection (CLABSI) can be life-threatening. Call your doctor at any sign of infection such as pain, redness, swelling, or fever.
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Reviewed: June 2018