• A central line is an IV (intravenous) line that goes into a large blood vessel near the center of the body.
• Central lines are used for giving medications, fluids, IV nutrition and drawing blood.
• The central line is usually placed in the chest area. Part of the line goes under the skin and enters a blood vessel several inches away. This type of line is called a tunneled central line.
• The tunneled central line has a cuff under the skin near the exit site. The cuff is a small felt-like piece of material that circles the line. Skin will grow around the cuff to help hold the line in place. The cuff also acts like a barrier to decrease the chance of infection.
• The central line may have a single or double lumen. A single lumen central line has one opening or tube. A double lumen line has two separate tubes within one tubing.

How a Central Line Is Placed

• The central line is placed in the operating room while the child is asleep.
• The entry site is a small incision where the central line enters the blood vessel. It is usually covered with a small piece of tape called a Steri-Strip. The Steri-Strip will come off as the incision heals.
• The exit site is where the central line comes out of the body. The exit site is always kept covered with a sterile dressing.
• The central line is stitched in place at the exit site during surgery. These stitches hold the line in place until the skin grows around the cuff. This usually happens in the first few months. Your doctor or nurse will decide if the stitches need to be removed.

Caring for a Central Line at Home

• A home care infusion company will give you the supplies needed to care for the central line at home.
• The central line is flushed daily to keep it from clotting. You are taught how to do this by a nurse from your home care infusion company.
• Change the dressing and cap weekly. Also change the dressing if it comes loose and is no longer covering the exit site. A nurse will do this until you are trained to do so.
• There may be some some bleeding after surgery and a dressing change may need to be done sooner than one week.
• Keep the central line safe by using the securing device supplied by the home care infusion company and avoid tugs or pulls on the line.
• Anyone else caring for your child, such as babysitters and teachers, will need to learn central line safety and emergency care.

Safety Guidelines for a Central Line

• Keep the central line dry. Protect the line during bathing. You can cover it with saran wrap or a plastic bag to keep water from getting to the central line.
• Avoid pulls or tugs on the central line and use the securing device to keep the line in place. Infants and toddlers should wear a one piece undergarment to protect the line.
• Avoid lifting under the arms when picking up infants and young children for the first two months after the line is placed.
• Older children need to avoid any activities that could cause damage to the central line, including contact sports.
• Your child can return to school with a central line. Arrangements can be made for a nurse to visit the school to assist with return to school.
• Keep an emergency kit with your child at all times. The emergency kit should have tape, a clamp, gloves and gauze and you will be taught how to use the items in the kit should an emergency occur.

Possible Problems with a Central Line

• Infection
• Blocked or clotted line
• Central line dislodged
• Hole or tear in central line
• Air in bloodstream

Signs of a Problem

A skin infection at the central line site is possible if there is:

• Redness
• Drainage
• Pain
• Swelling
• Warmth

A bloodstream infection is possible if your child has:

• Fever
• Chills
• Sweating
• Drowsiness or dizziness
• A sick feeling

Blood can clot inside the tubing and cause a blocked or clotted central line. You would know there is a blockage if:

• The central line becomes very hard to flush or you cannot flush it at all
• An IV solution will not go in through the central line
• A pull or tug on the central line could dislodge the line. It could also cause damage to the central line.

It is possible to get a hole or tear in the central line. You may be able to see the hole or tear. There could also be damage that you cannot see. Signs of damage:

• Wetness under the central line dressing or along the tubing
• An area of bulging on the central line
• A pink area on the central line that does not clear with flushing
• Puffiness or swelling on the skin near the central line

Air in the bloodstream is very rare. But it could happen if the cap came off the end of a central line that is not clamped. It could also happen if there was a cut or tear in the central line. It takes a large amount of air in the bloodstream to cause a problem. If air gets into the bloodstream, your child could have:

• Trouble breathing
• Chest pain
• Coughing

If There Is a Problem with a Central Line

Call the doctor or nurse if your child has:

• A fever
• Chills, sweating, drowsiness and feels sick
• Trouble breathing or chest pain
• Any redness, swelling, pain or drainage around the central line
• Feeling that something isn’t right in the chest area
• Bulging area on central line or wetness under dressing

Preventing a Problem with a Central Line

• Wash your hands before doing any central line care and wear gloves.
• Always keep a clean and dry dressing over the central line site.
• Follow the instructions for cleaning the cap and using sterile equipment.
• Avoid tugs or pulls on the central line. Take extra care when removing clothing to avoid a pull or tug.
• Secure the central line to your child’s body with the clips. For younger children, use one-piece outfits to cover the central line.
• Always keep scissors and all sharp objects away from the central line.
• If the central line is hard to flush, do not try to force it.