Central line care

Central Line safety advice for nurses and parents

A Hickman/ central line is a thin, flexible tube which is inserted into a large vein in your child’s neck. The other end of the tube is tunnelled under your child’s skin and comes out (somewhere on the chest). This end of the line will be held in place by small stitches for as long as your child needs the line (it can be left in for weeks or months). The line will be looped and covered with a clear dressing, with small children steri strips are also used for extra security.

Please check that your child’s line is securely looped underneath the dressing. This will reduce the risk of accidental dislodgement.

You child can be sent home with a central line.

You will be provided with a safety pack containing the following items:

• 1 x pack sterile gauze
• 1 x large IV 3000 dressing
• 1 x small IV 3000
• 2 x blue clamps
• 2 x bionectors
• 4 x sani cloth CHG 2%
• 1 x roll transpore

The safety kit should accompany the child at all times, anyone caring for the child must be familiar with the pack and must have received safety training.

Please note that if your child develops a temperature of 38 degrees and above you should contact your local hospital immediately as your child could have a line infection or sepsis. 

If worried or unsure please ring 999 and ask for an ambulance to take you to your local hospital.

Hickman/central line safety advice including daily care and observations

Infection

• Observe the exit site and neck wound for any signs of infection
• Redness
• Swelling
• Pain
• Heat
• Discharge i.e. blood/pus
• Should any of the above occur please take your child to their local hospital or call your community nurse for assessment.

If infection is the case:

• Your child will require an assessment, swabs and blood specimens to be taken
• If the central line is infected then it will need prompt treatment
• If the dressing is soiled with blood or there is wetness under the dressing it will need to be changed as this increases the risk of infection
• If the dressing remains intact and there is no oozing then the dressing needs to be changed once a week by the children’s’ community team.

Keeping the Hickman/central line dry

• The end of the central line can be taped out of the way when your child has a bath, please ensure that the end does not get submerged in the bath. Some families find it useful to place the bung in a plastic bag, using cling film or a sandwich bag and also tap the line(s) over the shoulders during bath time.
• The end should not be dangling down by the nappy/groin area, if they do get soiled, the bionector (caps) at the end of the line will need to be changed and the line should be cleaned thoroughly.
• If the bionector (caps) falls off, you must wash your hands thoroughly, clean the end of the cental line using a sani cloth CHG 2% for 30 seconds, allow to dry for 30 seconds and replace the bionector, ensuring that you do not touch the key parts (end of central line and the connection of the bionector. Never put the old bionector back on.

Breakage

There are two blue clamps in the safety pack that you should carry with you at all times. If the central line breaks, is accidentally cut or there is a hole in it you should;

• Wrap a piece of occlusive dressing (e.g IV 3000) around the break, to ensure the line does not get dirty
• Then wrap a piece of gauze around it to make the clamps fit more securely this also prevents damage that the clamps can do to the central line.
• Use the  two clamps provided to clamp one must above the cut/break and one closer to the chest.

Please take your child to your local hospital who will check that the central line has been clamped properly and will make arrangements to repair the line. Call an ambulance if unsure.

If you do not have the clamps with you, you should bend the line over and hold with your fingers and ring for an ambulance.

Daily checks

Check that your child’s line is securely looped underneath the dressing.  This will reduce the risk of accidental dislodgement.

Check that the white clamp(s) are closed always at the thick partof the line.  This will reduce the risk of blood loss if the caps were to fall off or the line broke near the hub. If you find that the clamps are open, you should close them and ask the community nurse to come and flush the line, to prevent it getting blocked.