Tunnelled lines

A tunnelled line (sometimes also called a Hickman line) is a long, flexible tube that is inserted under your skin, usually on your chest just below your collar bone.

The line runs under the skin and then into a large vein, normally in your neck. It is used for giving fluids, chemotherapy or medicine into your bloodstream. It can also be used for taking blood samples.

If necessary, a tunnelled line can stay in for several months and you can go home with it.

Tunnelled lines are used in many different situations. Some patients may need a tunnelled line to avoid having needles put into their arms every time they need treatment or a blood test. Others need a line because of the type of treatment they are having, or to help reduce the amount of time they spend in hospital.

If you are unsure why you are being offered a tunnelled line, please speak to the team looking after you or one of the central venous access nurses.

We are a nurse-led team who specialise in intravenous lines (lines situated within a vein), including tunnelled lines. We will put in your tunnelled line or arrange for it to be done by a radiologist.

We can also provide expert advice before and after your line insertion.

Please feel free to ring us on 020 3447 7491 if you have any questions.

An alternative would be a PICC or an implantable port.

Your doctor or nurse may have suggested a tunnelled line for you but if you would like to find out more about these alternatives, please talk to the team looking after you or one of the central venous access nurses. Leaflets about these lines are also available on our website.

If you are an inpatient, the nurses and doctors on the ward will advise you on how to prepare. If you are an outpatient, one of the central venous access team members will give you detailed information about preparing for your appointment. You may need to have a blood test before the insertion.

Many patients have their tunnelled lines inserted under local anaesthetic alone but you may prefer to have an intravenous sedative as well. This is to help you relax. If you decide to have a sedative, you may need to attend a pre-assessment clinic to make sure you are fit for sedation. If you take tablets or injections to thin your blood, these may need to be stopped for a short time. This is to prevent any bleeding during the tunnelled line insertion.

If you are an outpatient, you should discuss this with the doctor who prescribes your blood-thinning medicine. One of the central venous access team members will also talk through the plan with you.

If you have ever had an infection called MRSA, please let your doctor or nurse know. You may need to have a nose swab to see if the infection is still present before your tunnelled line can be put in.

We want to involve you in all the decisions about your care and treatment. The team looking after you will answer any questions you may have so please ask if anything is unclear.

If you decide to go ahead, we will ask you to sign a consent form.

This confirms that you agree to have the procedure and understand what it involves.

A specialist nurse or a doctor called an interventional radiologist will insert your tunnelled line. To reduce the risk of infection, the doctor or nurse will wear a surgical gown with a hat and mask.

You may be attached to a heart monitor and fitted with an oxygen mask. If your line is fitted by an interventional radiologist, X-rays will be taken during the procedure to check the position of the line. If it is fitted by a specialist nurse, he/she will use a heart monitor to make sure the line is placed correctly. This technique is called ‘ECG tip location’ and your nurse will explain it to you in detail. It usually takes about half an hour to put the line in, but you should allow several hours for the appointment. This is because it will take time to check you in and prepare equipment.

The nurse or doctor putting in your tunnelled line will also need to talk it over with you beforehand. If you are having sedation, you will need some recovery time before going home.

Your appointment may also be delayed if there is a patient who needs to be seen urgently.

If you are an inpatient, you will be taken back to the ward. If you are an outpatient, you should be able to go home on the same day. We will ask you to arrange for a friend or relative to accompany you home if you are having a sedative. Someone should stay with you overnight too.

If needed, the tunnelled line can be used straight after it has been put in. You may feel a bit sore and bruised around the insertion site for a few days after the procedure. You can take mild painkillers, such as paracetamol, to ease this. Once the bruising has settled down the tunnelled line should be painless but you may have a cold sensation when your line is being used for fluids.

A tunnelled line can stay in for several weeks or months. A specialist nurse from the central venous access team will remove it when you no longer need it.

Removing the line is a minor procedure which can usually be carried out under local anaesthetic.

Risks during insertion

Most tunnelled line insertions go smoothly. There is a very small risk of puncturing a blood vessel in the chest, air entering your bloodstream or a collapsed lung. These complications can be serious but we take every precaution to prevent them and they are very unlikely to happen.

Infection

It is possible for an infection to develop in the skin around the tunnelled line or in the bloodstream.

Contact your nursing or medical team, or one of the central venous access nurses, as soon as you can if you experience any of the following symptoms:

• a high temperature (over 38°C)
• feeling shivery
• redness or discharge where the line was inserted.

If you have an infection, you will need to take a course of antibiotics and your tunnelled line may need to be removed.

Blood clot

It’s possible for a blood clot (thrombosis) to form in the vein used for the tunnelled line. If you notice swelling or pain in the shoulder, neck or arm on the same side as the line, contact your nursing or medical team, or one of the central venous access nurses, as soon as possible. If you have a clot, you will need medication to dissolve it. The line can often stay in place.

There is also a small risk of a blood clot on the lungs. This is rare. If you experience chest pain or sudden shortness of breath, go to your local Emergency Department (A&E), or call an ambulance.

Blockage

Tunnelled lines can sometimes become blocked. We can usually unblock them by using a special flushing solution. Occasionally if this fails, the line will need to be removed.

Breakage

On rare occasions the tunnelled line may develop a leak. This could cause an infection or allow air to enter your bloodstream which can be serious.

If you notice a hole or a leak in your line, try to stop air from entering your bloodstream by folding the tubing back on itself and taping it with household tape. Contact your nursing or medical team, or the central venous access team immediately as your line will either have to be repaired or removed.

Tunnelled line moving out of place

For the first 21 days there will be stitches around the line to hold it in place. During this time the line will become embedded in the tissues which will hold it in place once the stitches are removed.

Rarely the line may fail to embed properly and can actually fall out. To reduce the risk of this you should avoid pulling on the line at all times. If it does fall out, please contact your nursing or medical team as soon as possible.

This will depend on the type of treatment you are having. You should discuss your options with your doctor or nurse, or contact the central venous access team on 020 3447 7491 if you have any concerns.

Dressings and stitches

You will have a small dressing on the side of your neck. This and any stitches will be removed after seven days. You will also have a dressing where the line comes out (the ‘exit site’). This should be changed weekly and the stitches will be removed after 21 days.

You will probably need to keep a dressing on the exit site as long as the tunnelled line is in place, even after the stitches have been removed.

Other care

The line will need to be flushed once a week to stop it from getting blocked. This is a painless procedure where a syringe is attached to the line and fluid is flushed into it.

Dressing changes and line flushing can be done by nurses at the hospital or by a district nurse – you will need to make an appointment to have them done. Some people prefer to care for the line themselves, or for their partner, a family member or a close friend to learn.

If this is something you would like, please talk to one of the central venous access nurses.

It’s important not to get the exit site wet for the first three weeks.

Showering

We will give you a transparent dressing to put over the exit site to keep it dry during a shower. If you have a dry dressing instead, you will need to keep shower water away from it for the first three weeks.

After that time you can let the exit site get wet in the shower but you will need to clean and dry the skin around the exit site and put a new dressing on after your shower. We will talk to you about this in more detail. If you are unsure about what to do, please contact your nursing or medical team.

Having a bath

If you have a bath while the line is in, you should keep the exit site out of the water.

While your tunnelled line is in place, contact your nursing or medical team, or one of the central venous access nurses, if you notice any of the following:

• a high temperature (over 38°C)
• feeling shivery
• a sore or swollen neck, shoulder or arm
• your line becoming displaced
• a hole or leak in your line