CHILDREN'S CANCER - Central Lines |
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| Children undergoing treatment
for cancer will often require repeated blood tests and insertion of needles to enable
chemotherapy and other drug treatment to be given. Even though doctors and nurses are very
experienced at taking blood and inserting needles it can sometimes hurt and is not a
pleasant experience for the child. Many children therefore have a special device called a central line, which is used to take samples of blood and to administer chemotherapy and other drugs (such as antibiotics). It can also be used to give blood or platelet transfusions. A central line is a fine plastic tube, which is inserted into a vein in the child's chest. This procedure is carried out under a general anaesthetic. When inserting the line, the surgeon makes a small cut into a vein in the neck and feeds the line down towards the heart. The other end is then tunnelled under the skin to emerge on the front of the chest as an external line. A removable bung is placed on the end of the line, which allows sampling of blood or injection of drugs. Although inserted in a similar fashion, some lines do not come out through the skin. Instead, the line ends in a reservoir or 'port' that is buried under the skin. The port acts like the bung at the end of the external line, but remains inside the body until the line is removed. As nothing comes out through the skin ports can be easier to look after but they still need to be accessed with a needle. Central lines can remain in place for many months and are a very good way of avoiding the discomfort of repeated injections. However, there are three main potential problems: falling out, blockage and infection. Sometimes it is obvious why a line has fallen out, eg the toddler who runs about while still attached to a drip stand. Other times it is not so clear such as when a child wakes up and the line is next to them in bed. Fortunately, lines that fall out do not normally lead to much blood loss. Blood may ooze down the tunnel under the skin where the line was but because this is not a proper vein, the blood clots and seals it off very quickly. Occasionally lines may appear to be blocked. This can be caused by the tip of the line lying at an odd angle against the wall of the vein, or the line becoming clogged even if it has been flushed regularly. If this happens things can be done to relieve the blockage so that the line can be used again. Despite being carefully looked after, many lines become infected. Antibiotics are given but sometimes the line may need to be removed. Before your child is discharged home the nurses will show you how to care for the central line. Make sure that you feel confident about this and don't be afraid to ask any questions. If you do have any problems contact the hospital staff who will be happy to offer advice.
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