Central lines are large intravenous lines placed into veins such as the internal jugular vein (neck), subclavian vein (chest) or femoral vein (groin). They can be used to administer multiple medications, fluids and blood transfusions at the same time (depending on the number of lumens, which are the entry sites), take blood without the need for venepuncture, and for measurement techniques such as measuring central venous pressure.
Central lines are commonly used in oncology and haematology as patients are likely to require IV chemotherapy, fluids, electrolyte replacement, IV antiemetics, blood transfusions and daily blood tests.
TYPES OF CENTRAL LINES
PORT/Portacath: A small, usually circular, appliance that is inserted under the skin in the chest. It is connected to a line that enters a large vein. The appliance is made of a rubber type material that is usually “accessed” by inserting a needle attached to an IV line, secured with a dressing. The advantage of the PORT is that it can be kept in the body without being accessed for long periods of time, and therefore only accessed when required.
Vas Cath: A type of central line that is usually used for dialysis in renal patients. It has at least two lumens - one to take blood from the body and one to return it. There may be a third lumen for the administration of IV fluids or medications.
Hickman’s Line: A type of tunnelled central line that is usually inserted into the jugular vein, with the exit site at the chest. It is usually used for chemotherapy in cancer patients, but can also be used for IV fluids and medications, to take blood, etc. Hickman’s Lines may be inserted for apheresis, such as stem cell collection.
PICC Line: A peripherally-inserted central catheter is inserted into a vein in the arm, and then advanced through into the the larger veins with the tip usually resting in the distal superior cava. They are thought to have lower rates of infection, and reduced likelihood of a pneumothorax upon insertion.
NURSING TIPS IN THE CARE OF CENTRAL LINES
- Know that the line is in the correct place before using it. Central lines will be xrayed once inserted to ensure they are placed correctly.
- Know when the line’s dressing needs to be changed. Central line dressings should be done aseptically, and may be done every week (depending on the facility’s policy). Dressings should be changed if they are lifting, to prevent infection entering the area.
- Make sure you look at the insertion site before using the line. Look for redness, ooze and swelling, feel for heat, and ask the patient if they have any pain. Pain should only be present initially from the insertion of the line.
- Don’t forget to lock the line with heparin when they are not connected to fluids. Some lines (e.g. apheresis Hickman’s Lines) require certain amounts of heparin, which should be written on the lumen.
- If you don’t know how to use a central line, ask!!!