Central lines
You can have chemotherapy into the bloodstream through a long flexible plastic tube called a central line.
These are called central lines because they end up in a central blood vessel in your chest, close to your heart.
There are different types of central line. One type goes in through a vein in your neck. This is called an acute central line and is used for short term treatments.
Another type of line goes in through your chest. It then goes under your skin to a large vein by your collarbone. The only bit you can see is the length of line that hangs out of the small entry hole in your chest. This is called a skin tunnelled central line.
At the end of the length of line that you can see, there are connection ports where the nurse attaches your chemotherapy. The connection ports are kept closed with caps. This is a picture of a skin tunnelled central line in place.
Other central lines you may hear about are portacaths and PICC lines.
Before a tunnelled line is put in, you have a general or local anaesthetic. Sometimes doctors use continuous x-rays as they put the tube in, so they can see where it’s going. Your doctor may want you to have an x-ray afterwards to make absolutely sure the end of the tube is in the best place.
When the tunnelled line is in, they will stitch it in place or put special dressings over it, so it can't come out. You can move about normally – for example, it won't come out while you’re sleeping or dressing. This is because there’s a small cuff on the line, which is under the skin and holds it in place.
The tunnelled line can stay in your vein for many months. So you won't need to have needles into your hand or arm each time you have your chemotherapy treatment.
Your doctor and nurse can also take blood from the line for tests. They can also use the line to give you fluids or other treatment such as antibiotics if you need them.
The video below shows how a tunnelled central line is put in. Click on the arrow to watch it.
How a tunnelled central line is put in
You lie on a tilted bed with your head turned to the left and lower than your feet.
The doctor cleans your skin with antiseptic solution and injects a local anaesthetic into your neck and chest.
They then put a needle through your skin and into a vein and thread a guide wire through the needle into your vein.
Next, they make a small cut in your neck and chest and, using a tunneler put the line through the cut in your chest passing it under your skin and out of the cut in your neck.
Then they remove the tunneler.
Next, they put a covered dilator over the guide wire into your vein.
Then they remove the guide wire and dilator leaving the cover in your vein.
The doctor feeds the line into the cover in your vein and then removes the cover.
Next, they take blood to check it is in the correct place then stitch the cuts in your neck and around the line and put dressings over them.
Finally, you have an X-ray to check the position of the line. The line is then ready to use.
Possible problems
Sometimes problems can happen with tunnelled central lines:
- you may get an infection
- the line may get blocked
- a blood clot can develop
- the line may split, but this is very rare
Your nurse will always test your tunnelled central line to check for blood return and to test with salt water (saline). It’s very important to tell your nurse if you experience pain as the line is flushed or during chemotherapy. This could mean the line has split.
The line is flushed regularly with heparin (an anti clotting drug) or saline to clean the line and prevent clotting. The nurses on the ward can teach you or your carer how to do this. Your district nurse can care for your line or help you at home at first.
It’s very important to avoid getting an infection in the area where your line goes into your body. Phone the hospital and speak to your chemotherapy nurse or doctor if you notice any redness, swelling, oozing or soreness. These could be signs of infection.
You’ll need to have treatment with antibiotics straight away if you do develop an infection. Otherwise, a doctor or nurse may have to remove the line and put a new one in.
If you are not having treatment regularly, you or your nurse needs to clean and flush the line regularly to keep it clear and to stop you developing any problems.
