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>> DOCTOR MALLORY: Hi I'm doctor Mallory. You or someone you love has a central line
and it's important that you know what that is, how it is used, and what the risks are.
In this video I will have a brief conversation with a patient who is scheduled to get a central
line placed. I will review what lines are, how they are used, and the risks associated
with them.
Hi Julie. I understand that you are going to have a central catheter and you have some
questions about it.
>> PATIENT: Yeah, I do have some questions. Can you explain to me exactly what a central
line is? >> DOCTOR: A central venous catheter, or a
central line, is a thin flexible plastic tube that is placed into a large vein. Intravenous,
or I.V. medications, blood products, and other fluids can be given through the central line.
There are a few different types of central lines and all of them fall under two main
categories. The first is an external catheter. One type of external catheter is surgically
inserted into a large vein near the heart. The other end comes out from under the skin
in the chest. Another type is a peripherally inserted central catheter, also called a PICC.
This catheter is inserted into a vein in the arm and advanced into a large vein near the
heart. For any of these catheters, the tube that
sits outside of the body may branch into one, two, or three smaller tubes. We call these
lumen. Each of these has a cap on the end and medications are injected into the cap
and go through it and into the catheter and directly into your veins. These lines can
stay in for a month to several years depending on the specific external line that is placed,
and on the needs of the patient. >> PATIENT: Ok, so I understand what the external
lines are, what's the second type of line? >> DOCTOR: The second type of central line
is surgically inserted completely under the skin. This is called an implanted port. This
line is usually placed in the chest, but may sometimes be placed in the arm. One end of
the thin tube is fed into a large vein while the other leads to a small rubber dome, or
port, just under the skin. When medications or fluids are given, a special needle, called
a non-coring needle, is inserted through the skin into the port.
When not in use the needle can come out leaving nothing visible outside the skin except a
small bump. >> PATIENT: Can you explain why central lines
are needed?
>> DOCTOR: The main reason is to allow doctors and nurses to give you medications, fluids
or blood products that can not be given into a small vein in your arm or hand. Central
lines last longer than other types of IV's and avoid the need for multiple needle sticks.
>> PATIENT: Can you use a central line to draw blood off of as well for lab work?
>> DOCTOR: Well, technically a central line can be used to obtain blood samples. However,
we really try not to. Each time a central in is used there is a chance for infection
to occur, and studies have shown that drawing blood from a central line particularly increases
that risk. To minimize it, we will use a vein in your arm or hand to draw blood whenever
possible.
>> PATIENT: Are there risks when you have a central line?
>> DOCTOR: Like all health care procedures, there are risks to having a central line.
The main risk is getting an infection in your line. Your health care team uses strict sterile
technique when placing the lines to try to reduce this risk. Also, the team will always
use strict cleaning procedures while using your line.
It is also possible for a blood clot to form in or around your catheter. This may cause
swelling in your arm or neck or a blockage in the catheter. Using a syringe, a small
amount of fluid is "flushed" into the line daily, or after it is used, to decrease the
risk of a clot forming.
There are also risks related to placing the line. Some bleeding can occur at the site
of insertion. Usually, the bleeding is very minor. Additionally, a line placed in the
chest could cause a collapsed lung. This can happen anytime someone performs surgery on
your chest.
Finally, you will be having local or general anesthesia during the procedure to place the
line. These medications can affect how you breathe and to reduce that risk, your health
care team will monitor you very closely when they are placing the line.
>> PATIENT: It sounds like my health care team has a lot of things to know about central
lines. What do I have to know as the patient?
>> DOCTOR: The most important thing you can do as a patient is to be familiar with how
to care for a central line. As a patient, you are an important member of your health
care team. If someone is using your line, don't be afraid to speak up if you see something
that you are not use to or are unfamiliar with.
You will receive written instructions for caring for your line at home which includes
when to call your healthcare provider. In general, if you have any questions or are
having any problems with the line don't hesitate to call.
>> PATIENT: Thanks Doctor Mallory. I have learned a lot about central lines.
>> DOCTOR: You're welcome. Thank you for choosing Maine Medical Center for your health care.
I hope this has explained some of the basics of central lines. At Maine Medical Center,
we are here to provide the best care possible for your line. If you have any questions,
ask a member of your healthcare team. Remember, it is your line and as a patient, you are
an important member of the healthcare team. Thanks very much for your time.