Tunneled Central Line

What is a tunneled central line?

A tunneled central line is a long, thin tube (catheter) that provides long-term venous (vein) access. The line extends into a large vein near your child’s heart.

A tunneled central line is a type of central venous catheter (central line). This type of central line is burrowed under the skin.

A tunneled central line is sometimes known as a tunneled catheter, Powerline®, Hickman®, or Broviac® catheter. It allows medicines, nutrition, blood products, and fluids to be given to your child. Blood samples can also be taken.

Tunneling the central line under the skin helps to keep it in place and lower the chance of infection. With good care, the tunneled central line can stay in place for months to years before it needs to be removed. It is important to take care of the central line and follow all instructions to prevent infection and keep it working properly.

How a tunneled central line works

The care team inserts the central line into a vein under the collarbone (subclavian vein) or in the neck (jugular vein). They guide the line until it reaches the correct place near the heart. The end of the tubing comes out through an opening in the upper part of the chest. 

One end of the tunneled central line stays outside the skin and has 1 or 2 tubes called lumens. Each lumen has a cap called a needleless connector placed on the end. The connectors keep the lumens from leaking. They also keep air and bacteria out.

Your child will wear a dressing (bandage) over the area. The line also has a Dacron® cuff around the tubing just under the skin on the chest. The cuff feels like a small bump under the skin. Both the dressing and cuff hold the line in place and act as barriers to infection.

Benefits of a tunneled central line

Benefits of a tunneled central line include:

• A tunneled central line reduces the need for needle sticks for medicines, fluids, nutrition, blood products, and blood samples.
• A tunneled central line is easy to access.
• A tunneled central line can stay in place for a long time.
• Some medicines can irritate your child’s blood vessels. A tunneled central line is placed in a large vein with high blood flow so there is less irritation.
• You can give medicines through a tunneled central line at home, making it easier for your child to continue therapy.
• With some types of tunneled central lines, you can give more than 1 type of medicine or liquid at the same time.

How a tunneled central line is placed

Knowing what to expect can help you and your child feel more comfortable before and during tunneled central line placement.

Your child will have general anesthesia for tunneled central line placement. This means your child will not feel pain or be aware during the procedure. It is important to follow NPO instructions about when your child must stop eating and drinking before the procedure. The entire process, including anesthesia and recovery, usually takes about 1–2 hours.

Risks of a tunneled central line

Every medical procedure has some risks, including those that involve anesthesia and surgery. Your child’s care team takes steps to keep these risks as low as possible.

Risks during tunneled central line placement

While the tunneled central line is being placed, possible risks include:

• Puncture of a blood vessel
• Insertion into the wrong blood vessel
• Damage to nearby structures or organs
• Blood clots forming in the vein
• Irregular heartbeat
• Nerve injury
• Infection
• Bleeding
• Allergic reaction to medicines or contrast (x-ray dye) if used

Risks after tunneled central line placement

Possible complications include:

• Blood clots
• Movement of the tunneled central line out of position
• Crack or kink in the line
• Air bubble in the line
• Air in the veins
• Blockage in the line
• Inflammation or irritation of the vein
• Infection
• Irregular heartbeat - rare
• Lung collapse (pneumothorax) - rare

Important information

Serious problems are rare, but they can happen. Always ask questions if you are unsure about any part of the procedure. Follow all instructions from your child’s care team.

How to care for a tunneled central line

Your care team will teach you how to care for the tunneled central line. Always follow your care team's instructions to keep the line working properly and take steps to prevent infection.

Lines must be flushed daily with heparin. Heparin is a medicine that keeps the blood from clotting and blocking the line.

Your child will wear a dressing over the area to prevent infection and keep the line in place. The dressing must be changed once a week. The dressing must also be changed if it gets wet, dirty, or comes off. It is important to keep the dressing from getting wet during bathing.

Always follow your care team's instructions for how and when to care for your child's tunneled central line.

Early healing

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 up your child under the arm on the same side as the central line. This may cause discomfort.

Living with a tunneled central line

Medicines can be given with a syringe or an IV bag. Let your care team know if your child has any pain or discomfort while receiving medicines.

Follow all care instructions to keep the line working properly and to prevent infection. Always wash your hands before touching the tunneled central line. Clean the needleless connector before and after each connection to the line.

Your child should avoid activities that could damage the line, such as contact sports or rough play. Your child should not swim or submerge in water with a tunneled central line because it increases the risk of infection. Tell your child’s teachers, school nurses, and other caretakers about the tunneled central line.

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.

Preventing infection

Patients with a central line are at risk for a serious infection known as central line associated blood stream infection (CLABSI), which can be life-threatening. To help prevent infection: 

• Always wash your hands before and after doing any line care. 
• Keep the central line site clean and dry. 
• Make sure the dressing and needleless connectors are changed every 7 days or more often if needed. The dressing should be changed if it becomes wet, dirty, or loose.
• Make sure your child bathes and changes clothes daily. 
• Change your child’s bed linens once a week, or more often if they are soiled. 
• Practice good oral care to reduce mouth bacteria, including brushing teeth twice a day. 
• Seek medical care right away at any sign of infection, such as pain, redness, swelling, drainage, or fever.  

When to call your care team

Call your care team if you notice any of the following: 

• Redness, pain, warmth, or swelling at the tunneled central line site that gets worse or does not get better in 24 hours
• Fluid, blood, or pus leaking from the tunneled central line site 
• Bleeding at the tunneled central line site that will not stop
• Swelling in the face, neck, shoulder, chest, or arm on the side of the body where the tunneled central line is inserted
• Fever (follow fever guidelines given by your care team)
• Chills, nausea, weakness, chest pain, shortness of breath, fast heartbeat, dizziness, or confusion
• The line is leaking, hard to flush, or will not flush

Questions to ask your care team

• Why does my child need a tunneled central line?
• How long will my child need a tunneled central line?
• What can I expect before, during, and after getting a tunneled central line?
• How often do I need to flush the line or perform other line care activities?
• What supplies do I need?
• What notes should I keep about line flushes and other care?
• Can my child shower or bathe while they have a tunneled central line?
• What activities should my child not do with a tunneled central line?
• Are there any long-term effects of a tunneled central line?
• How will I know if my child has an infection?
• When should I call the care team?

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