This information leaflet has been produced to give you general information and hopes to answer most of your questions regarding a Tunnelled line insertion. It is not intended to replace the discussion between you and the healthcare team, but may act as a starting point for discussion. If after reading it you have concerns or require further explanation, please discuss this with a member of the healthcare team.
A tunnelled line insertion is also known as a Groshong Line or a Hickman Line Insertion. This refers to the type of line that will be inserted.
Why do I need this procedure?
This procedure is needed for a number of different reasons
- You may need to be administered long term antibiotics
- You may need to be administered chemotherapy
- You may need to be administered medications and nutritional products
What are the benefits of the procedure?
Having a tunnelled line allows your doctor to either start your treatment or continue with your treatment if it no longer possible to put a cannula (plastic needle) into the veins in your arms. Having this line will prevent you from having to repeatedly have a cannula in a vein in your arm. Some medications must be given through a line that is in a large vein in your chest and cannot be delivered through a cannula.
How do I know if this is a suitable procedure for me?
Your doctor has suggested this as the most suitable route for your treatment to be administered. You will need to attend the radiology pre-assessment clinic to establish your general health. At this appointment you will need to have your blood pressure measured, and blood samples taken. A nurse will talk to you about the investigation. There will be plenty of time during this appointment to answer your questions.
If you are an inpatient these investigations will take place on the ward.
Can I take my medication as normal?
Most medication can be taken as normal. If you are taking Metformin or any blood thinning (anti-coagulant) medication such as Aspirin, Warfarin, Clopidogrel or Rivaroxiban, it is important that you let us know at your pre-assessment appointment.
What happens during the procedure?
Going to the ward
The procedure is usually a day case but occasionally an overnight stay is required (it may be worth packing an overnight bag just in case). You will be asked to go to a ward a couple of hours before the procedure. On the ward you will be asked to put a hospital gown on. You can continue to eat and drink normally.
A nurse will complete a checklist with you before leaving the ward. The procedure is performed in the x-ray department.
In the x-ray department
On entering the x-ray room a radiologist (x-ray doctor) or advanced practitioner (nurse who has done extra training to be able to place tunnelled lines), radiographer (person who takes the x-ray pictures) and a nurse will greet you. They will check your personal details and discuss the procedure with you, including where we will access the vein (access site). If you have not already signed a consent form this will be completed at this stage.
You will be asked to lie flat on the x-ray table with a pillow under your head. You will be awake during the procedure and there will be a member of staff nearby at all times to support you. Your blood pressure, oxygen levels and heart rate will be measured regularly.
It is possible to perform the procedure through a vein in your neck or chest. The skin over the vein where the line will be inserted will be cleaned. Some local anaesthetic will be injected into the skin and tissue around the vein and also in the area where the line will be placed under the skin. The local anaesthetic will make this part of your body go numb, like dental anaesthetic.
You may feel some pressure/pushing as a needle and a sterile wire is passed into the vein and the tunnel is made to allow the line to be placed. This should not be painful. A small tube is then placed over the wire that was originally inserted and the tunnelled line/ Groshong Line is passed through the tube into the vein. The x-rays will be used to see the position of the line in the vein. In some cases some contrast (x-ray dye) may be injected to check the position of the line.
You will have some stitches placed at the entry site on your neck and at the exit point of the line on your chest. Arrangements will be made for these stitches to be removed.
The procedure usually takes on average one hour, in some cases this may be longer depending on the situation. The nurses monitoring you during the procedure will keep you informed.
What happens after the procedure?
You will be helped back onto a trolley. There will be someone with you until the ward nurse arrives to escort you back to the ward.
You will need to rest for two hours following your procedure; this allows time to reduce the risk of bleeding from the puncture site.
A nurse will observe your access site regularly and continue to measure your blood pressure, oxygen levels and heart rate. If you feel any swelling, oozing or pain in the area of the access site, please inform the nurse immediately.
If you need to use the toilet during this time, please ask for a bedpan or bottle.
You will still be allowed to eat and drink after this procedure. After your two of rest you may be required to stay on the ward for up to two further hours for monitoring before you are allowed to go home.
If you are an inpatient the ward staff will advise when you are to be discharged.
What complications can happen?
As with all procedures there are some risks involved with the insertion of a tunnelled line.
There is a small risk of serious or life threating complications occurring in less than 2% of patients. These include air embolism (air tapped in the vein), arrhythmia (fast heart rate) and pneumothorax (air in the lining of the lungs).
The main risk of a line insertion is infection after the procedure, which may require treatment or in some cases the line may need to be removed. This risk is reduced as the procedure is performed as a sterile procedure and every risk of infection has been checked before you have your line inserted.
How soon will I be back to normal?
Most patients go home the same day but you may be asked to stay in hospital overnight following the procedure. This will be discussed with you at your radiology pre-assessment appointment.
The doctors will only send you home when they are satisfied with your recovery after the procedure.
If you are an inpatient this will be discussed with you by your doctor.
What happens if I decide not to have the investigation?
If you decide not to have the line insertion you will be referred back to your doctor and other options will be discussed. There are alternative types of line that can be placed into a larger vein. Some alternative lines are not suitable for long term use. Your consultant will discuss this with you before you have your procedure.
What if I have any special requirements?
If you have any special needs or requirements please discuss this with the nurse or doctor at your pre assessment visit or contact the x-ray staff on the numbers below.
Where can I get more information?
Any personal information is kept confidential. There may be occasions where your information needs to be shared with other care professionals to ensure you receive the best care possible.
In order to assist us to improve the services available, your information may be used for clinical audit, research, teaching and anonymised for National NHS Reviews and Statistics.
This leaflet can be made available in other languages and formats upon request.