Tunneled central line placement/removal

A tunneled central line is a thin tube (catheter) that is placed in a vein for long term use. It is most commonly placed in the neck (internal jugular) but may also be placed in the groin (femoral), liver (transhepatic), chest (subclavian) or back (translumbar). The catheter is tunneled under the skin. It has a cuff attached to it that allows tissue and skin to grow around it, giving the line more stability.

Procedure

The doctor will insert the catheter into a vein, usually in the neck, and thread it into the large vein that carries blood into the heart. The other end of the catheter is tunneled under the skin and exits from the side of the chest.

Anesthesia

Patients receive IV sedation or general anesthesia.

Pain

After the procedure, some children may feel mild discomfort around the site for several days.

Risks

This procedure is considered low-risk. However, potential complications include:

• bleeding
• infection
• puncture of adjacent structures (such as other veins or arteries)
• air embolism (air in the veins)
• collapse of the lung (pneumothorax)
• bleeding into the chest (hemothorax)
• catheter breakage (when it is being removed)
• allergic reaction to X-ray dye (contrast reaction)

Aftercare

Your child will have two bandages, one over the insertion site (usually at the neck), and one over the catheter at the exit site (usually on the side of the chest). After 48 hours you may remove part of the bandage at the insertion site. Take off the gauze and the clear bandage. The bandage over the catheter must remain clean and dry at all times. It should be changed once a week. The bandage may be changed at appointments or family members may change it at home if they have been trained to do so. Do not remove the bandage if you have not been trained.

Bathing

Your child shouldn't take a shower or bath for 48 hours. After 48 hours, your child may shower or bathe with the catheter-site bandage in place. If showering, your child should face away from the spray so water does not hit the catheter directly. If taking a bath, keep the bandage above the water.

Restrictions

Your child should be discouraged from activities, such as contact sports and rough playing, which may result in a pull to the line and lead to damage or loss of the catheter.

Removal

The procedure is performed with IV sedation or general anesthesia. Local numbing medicine will be injected into the skin around the catheter exit site (usually on the chest). The tissue will be loosened and the catheter removed.