A central line is a silicon tube that is inserted (tunnelled) under the skin in the chest through a major vein in the neck and the tip sits in the large vein just above the heart. This will enable us to give drugs and to take bloods. There are two types of central lines commonly used; a Hickman line and an implantable port.

Hickman Line

A Hickman Line is a silicon tube surgically placed in the child’s chest. It is tunnelled under the skin and through one of the major veins in the neck until the end sits in the large vein just above the heart. We are then able to take blood samples and give medication or blood products when necessary via the external lumens without the need for repeated needles for your child. A Hickman Line can stay in place for several months.

When the central line is not being used there is a small risk that it may become blocked. To stop this happening a small amount of fluid is 'flushed' into the line using a syringe. This is usually done once a week. The caps or bungs at the end of each lumen should also be changed every week. The dressing on the site it will need to be changed once a week. The nurses at the hospital may teach you how to do this for your child if you feel able to, or a Children’s Community Nurse can do it for you at home. A Hickman line needs to be secured safely; your child will be provided with a ‘wiggly’ bag to place the lumens inside. This bag needs to be washed at least twice a week on a high temperature.

Implantable Port (Port-a-Cath)

An implantable port is a silicon tube surgically placed in the child’s chest. It is tunnelled under the skin and through one of the major veins in the neck until the end sits in the large vein just above the heart. The line has a port, a disc into which a special needle can be inserted, which sits directly under the skin on the chest wall. It will look like a little bump under the skin.

There are no external lines visible with a port and when the line is not in use the needle will be removed. There is a small risk of the line becoming blocked; it will need to be flushed with a small amount of fluid to prevent this. When not in use the port will need to be flushed every four weeks.

There may be times when your child is seen by people who do not access central lines. This is particularly relevant to emergency admissions. At these times your child may need to have blood samples or a cannula inserted peripherally. We will always endeavour to minimise this.

Possible problems

Infection

It is possible for an infection to develop either inside the central line or around the exit site.

You should contact your local hospital if:

• The exit site becomes red or swollen or painful
• You notice discoloured fluid coming from the exit site
• Your child develops a high temperature

Your child will be given antibiotics, but if these do not clear the infection from the line it may have to be removed.

Blood clots

It is possible for a blood clot (thrombosis) to form in the vein at the tip of the line. If a clot does form, medication to dissolve the clot may be used and the line may have to be removed. Signs of a blood clot around the central line include swelling, redness and/or tenderness in the arm, chest area or up into the neck (on the same side as the central line). You should contact your local hospital immediately if you notice any of these signs or any shortness of breath or tightness of the chest.

Air in the central line (Hickman Line)

No air must be allowed to get into the central line. The clamps should always be closed when the line is not in use. The line must not be left unclamped when the caps (bungs which are at the end of each lumen) are not in place.

Break or cut in the line (Hickman Line)

It is important that you do not get a break or cut in the line. Do not use scissors near the line and only use the clamp on the thicker, strengthened part of the line. It is uncommon to get a cut or split in the line, but in the unlikely event of this happening try to clamp or tie the line immediately above the break (so it is sealed between the split and where the line comes out of your child’s body – the exit site). Call your local hospital as soon as possible. It may be possible to repair the line, but if this can't be done, the line will be removed.

Open Clamps

Over time and with continual use it is possible for the clamps on the lumens to become undone. It is important that you check that all clamps are closed on all lumens. If you notice that they have come undone you need to contact your local hospital as soon as possible as the lumens will need to be flushed.

Extravasation

Extravasation is when some of the chemotherapy drug leaks from the central line or cannula near to where it enters the skin. If this happens, small amounts of the drug seep into the tissue around the entry site. It is usually obvious when this happens because as the drug is given it does not flow properly. There may then be swelling/redness in the tissues around the site as the drug leaks out. There may also be a burning or stinging pain. Your nurse or doctor will always watch carefully to make sure this is not happening and at the first sign of any problem will stop the medication being given.
The main problem with extravasation is that certain chemotherapy drugs can cause serious irritation if they leak outside the veins. This means they can make the surrounding skin and tissue inflamed and sore. Usually this is uncomfortable or painful for a time. Rarely, it can cause serious skin damage. This may result in some scarring or even need treatment with an operation and a skin graft. EMCYPICS has an established guideline for the treatment of extravasation.