Your doctor may have talked to you about using a device called a ‘non tunnelled central venous catheter or ‘central line’. This factsheet explains how and why they are used.
What is a non-tunnelled central venous catheter?
A non-tunnelled central venous catheter or ‘central line’ is a fine tube which is put directly into your child’s large vein, usually in the neck or groin. This allows us to give medicine or fluids to your child through the catheter, and it can also be used for blood collection if needed. It is used for a short time in emergency or acute situations, for up to 2 weeks. They are sometimes called jugular or femoral lines.
Why does my child need a non-tunnelled central venous catheter?
- For emergency situations
- For major surgery
- If they have difficult/small veins
How is this catheter put in?
- Your child will need to be asleep to help them keep still for the procedure. This usually means having a general anaesthetic.
- The catheter is put in by a doctor who has been specially trained.
- The procedure is done in an operating theatre to reduce the risk of infection. These lines may also be inserted in the Emergency Department or the Intensive Care Unit.
- An X-ray is done after the catheter has been put in to make sure the tip of the catheter is in the correct position and is safe to use.
Potential challenges with insertion
- If your child’s veins are very small, the line may not go in the first time and a different vein may need to be used. Sometimes the artery next to the vein can get damaged. This heals very quickly but your child may have a small bruise.
- There is a risk of bleeding or oozing around the insertion site in the neck.
- The position of the catheter may not be satisfactory on the X-ray and it may need to be repositioned.
How is this catheter kept in place?
- The catheter is kept in place using a clear dressing and a securement device. The dressing also acts as a barrier to prevent infection and allows the area to remain clean and dry.
- A securement device is used under the dressing which helps prevent the catheter from being accidently being removed. The dressing and the securement device must always remain in place.
What is ‘flushing’ and ‘locking’?
- ‘Flushing’ of the catheter occurs when a normal saline (salt water) solution is injected in the line to prevent it from blocking. This is typically done after medicines have been given or blood has been taken. Your child may feel cold when the line is flushed or they may get a salty taste in their mouth. However, this is normal.
- ‘Locking’ refers to when a solution made out of an anti-blood clotting agent (heparin or citrate) and sometimes an added antibacterial agent (taurolidine/Taurolock) is left in the line when it is not being used. This is typically done when the catheter does not need to be used for some time.
How is it removed?
The catheter is removed when it is no longer needed – that is, when treatment is finished, or if there is a complication or an infection. All staff removing the catheter are trained in this task and they follow a very strict protocol. The catheter can be removed in the ward and a general anaesthetic is not necessary.
Serious problems are very rare and most of the time this type of catheter is the best choice for your child, with the benefits outweighing the risks. However, it is important to know of the risks involved before you consent to the procedure.
As with any procedure there is a risk of infection. We try to reduce this risk by making sure everything is clean and sterile in the operating theatre. Signs of infection may include:
- Redness, pain, heat and swelling over the site where the catheter is inserted.
- A fever. If your child’s medical team thinks this may be related to the line, then it will be removed as soon as possible.
A common problem is blockage of the catheter.
- This happens if blood or medication gets stuck in the catheter.
- To prevent blockages the catheter will either have fluid running through it or be locked. All lumens must be flushed and locked weekly if not in use to ensure they do not block.
- A blocked catheter can sometimes be fixed by flushing it with an anti-clotting medicine. Sometimes the catheter is too blocked and needs to be removed.
The catheter may be pulled out by mistake.
- If this happens, any fluid or medicine running through the catheter will be stopped. Pressure will be applied to the exit site (either the neck or the groin) and medical staff will be informed immediately.
Air bubbles or ‘air embolus’
- There is a small risk of air bubbles entering the catheter.
- We make sure that there is no air in the syringes used to inject into the catheter.
- If there is a break or a leak in the catheter it is important to clamp it immediately, to prevent air from entering.
Very rarely there can be serious problems. These can be life-threatening.
- The catheter could damage or puncture the walls of blood vessels of the heart.
- A serious infection or blood clot could develop.
Before you consent to your child having a non-tunnelled central venous catheter or ‘central line’ put in, it is important to discuss any possible problems with your child’s doctor. The doctor will also explain any other risks and benefits of the catheter.
Please feel free to talk to your team doctor or your anaesthetist about any concerns you have. Being informed will help you make the best choice for your child.
(Write down any questions or concerns you would like to discuss with your doctor/nurse)