Leukaemia

Central lines

People with acute leukaemia begin their treatment by having so-called Intensive chemotherapy, involving daily intravenous infusions of chemotherapy drugs while staying in hospital’. To avoid the need for having needles put in their arms repeatedly, most people who need frequent intravenous drugs have a central line installed in a vein in their chest, arm or groin, which can stay in for the duration of treatment. Of the several types and makes of central line the most commonly used among the people we saw was a Hickman line. The central line can also be used for giving other types of treatment such as antibiotics, as well as taking blood samples.

Insertion of a central line is a minor surgical procedure usually done under local anaesthetic but a few people were also given sedation and some were given a general anaesthetic. Some people found the prospect of having a central line fitted scary, especially if they felt unwell and were still in shock from receiving their diagnosis. This problem was made worse if the procedure was not well explained to them. Waiting to have it done occasionally delayed the start of treatment. Having hers fitted made Claire realise how ill she was.

Some found having a central line fitted quick and easy; for others it was unpleasant or painful or the doctors had difficulties doing it. Similarly, removal could be quick and painless or difficult because skin had grown around the insertion site. Removal is done under local anaesthetic. The line is gently pulled out after cutting away any skin that is obstructing it. The procedure usually takes only a few minutes.

The line and the insertion site need to be cleaned frequently to avoid it becoming blocked or infected. Some people said they became aware of when it needed cleaning and reminded the nurses to do it. Others learned to take care of their line themselves. Some became expert and took control of this aspect of their care rather than let inexperienced staff do it. Neil let a junior doctor, who was learning about central lines, clean his line and the doctor asked Neil if he had flushed the line correctly. Ann still had her line in during a period at home and preferred to flush it out herself rather than travel to the hospital just to have it cleaned.

Infection of a central line was common (see ‘Infections and other treatment complications’). If an antibiotic didn’t control the infection, the line was removed. A replacement line was fitted if much more treatment was still to come. Julie initially had lines inserted into a vein in the groin, removed every time she went home, but they were eventually replaced by a Hickman line in her chest, which she found uglier and harder to hide but it could stay in when she went home.

Some people were self-conscious about how they looked with a central line in place and kept it covered, which restricted what clothes they could wear. Keeping it dry was important so swimming was not advised. Some found the central line uncomfortable; it was important to keep it well taped up so that it didn’t get accidentally pulled while sleeping. The central line and the scars it left were a reminder of the illness. But most people said that the disadvantages were far outweighed by the benefits of avoiding repeated jabs with a needle.

 Last reviewed: August 2015.

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