What is a line?

A semipermanent line is a plastic tube that is placed inside a large vein within the patient's chest. The line normally comes out of the vein just under the collarbone and then passes under the skin in a tunnel before coming out of the patient at the level of the breast. These lines have been used extensively for over 20 years but the original line, called a Hickman line, has been superseded for many patients in my practice by the Groshong line which is easier to manage. The line may consist of one, two or occasionally three channels or lumens.

Fifteen years ago I introduced ports for cancer treatment at St Bartholomews Hospital. These are very successful, and are now the system of choice for many cancer patients. The line is exactly the same, but the end is connected to a titanium chamber placed under the skin so that the entire system is inside the body. There is less risk of infection and no need to flush the line between use. I have redesigned the ports so they are small, light and unobtrusive.

There are also other types of lines for specific treatments, but each patient is individually assessed.

A line REDUCES discomfort and inconvenience. The risks are low and not usually life threatening. If you are advised to have a line, try not to worry. Lines are most sensibly inserted at the start of treatment - the worst scenario is to suffer all the problems of poor access before having a line later on in the course.

Most patients will have discussed whether to have a Groshong or port with their oncologist, but if you would like further information on the difference between the devices, please click here

In this country lines are most commonly used for chemotherapy, but other uses include intravenous feeding and long term antibiotic administration. The lines can be used for giving blood and other fluids whilst blood samples can be painlessly taken from the line.

Removing the line.

Whenever possible the line should be left in place until your consultant has no further need for it. I will then arrange to remove the line which involves coming back into hospital for a few hours. Lines are removed under a very brief anaesthetic lasting just a few moments and in over 90% of cases can be done without the need for any further stitches. Ports necessitate reopening the wound to remove the chamber, so you will need to keep the wound dry for a week afterwards. You may go home shortly afterwards but once again you must not have anything to eat for 6 hours and drink for 2 hours before the procedure and must be accompanied home by a friend or relative.

Please click here for Anaesthesia's terms and conditions

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LINES AND PORTS

This page deals with the most commonly asked questions, but does not aim to replace the normal consultation process. You will have ample opportunity to discuss any further questions before your line is inserted.

 

Advantages of Semipermanent lines.

An ordinary drip placed in the arm will rapidly become infected and often blocks off, so that it can only be used for a short period of time before having to be replaced. Moreover, if irritant drugs such as those used in chemotherapy leak out of the drip, they can damage the skin and produce painful reactions. Semipermanent lines, as their name implies, can be left for many months with less risk of infection or damage to the patient's own tissue. Drugs and fluids can be given and blood samples taken reliably even in patients with poor veins.

Inserting the Line

Lines and ports are either inserted on a day case basis or immediately before chemotherapy or other treatment is due to commence. It is essential that you have nothing to eat for 6 hours or drink for 2 hours before the time of the insertion, although you may take your normal tablets with a small sip of water. I urge you to have plenty to drink until then as dehydration is unpleasant and makes the operation considerably more difficult.

You should arrive at the hospital at least 2 hours before the time of the operation so that you are nicely relaxed while the line is being inserted.

The system is inserted in the operating theatre to minimise the risk of any infection. In the case of children, the line is inserted under general anaesthetic but in adults my normal practice is to do this under sedation. Most patients are totally unaware of the procedure but if you are at all unhappy about what is going on you will be able to tell me so that more sedation can be given. This technique is considerably safer than using a general anaesthetic and is well tolerated by all patients. Indeed, a minority of patients prefer not to have any sedation at all and this wish can be accommodated.

Local anaesthetic is used. The vein is located with ultrasound to minimize the risk of damage to other blood vessels or the lungs, and the insertion process is repeatedly checked with an X-ray machine to ensure that the line is in exactly the right position. After the operation, you will return to your room and be given something to eat and drink. You will have a small incision 1 cm long, normally below your collar bone, as well as the tube coming out of your chest. If you have a port, there will be a small scar where the port is placed. There will be a dressing over each site.

If you stay in hospital for your chemotherapy, the nurses will teach you how to care for your line while using it in front of you. If you are to go home the same day, the nurses will briefly show you how to care for your line and you may leave hospital as soon as they are happy that this has been achieved.

If you have a port the connector tube will be removed after your chemotherapy and you will just have two dressings which you will need to keep clean and dry for a week. You can still have a shower, but turn your back to the shower and try not to soak the dressings. After a week we will check the wound and if it is healed there are no restrictions. I close the incision with a sugar based closure device which means there are no sutures to remove. The greatest benefit is that you do not need to clean or flush a port, so effectively you can forget it is there!

A friend or relative will have to take you home after the insertion, and you should remain indoors for the rest of the day. Pain is minimal and patients rarely need more than a couple of paracetamol tablets for pain relief.

You will be given a copy of your Xray when you leave hospital. This must be taken with you to show the outpatient nurses the first time your system is used.

Living with your port or line

If you have a port there are no restrictions or requirements after the dressings are removed. You cannot flush your own port, but it should be flushed by your oncology unit every 4 weeks. Please click here for a sheet of instructions about your port

Lines on the other hand do need some maintenance but do not worry, this is very easy and overall your line will make your treatment easier and quicker. All patients with Groshong lines receive a patient booklet that is liberally illustrated and gives full instructions on how to care for your line when you leave the hospital. You will be given the telephone number of the oncology floor and your day unit, which you may telephone if you have any problems. You will be asked to return 10 days after the operation so that the stitches below your collarbone can be removed and the line examined. There will be some further stitches on the outside of the line, but these should not be removed except with my approval.

There are two important things to remember about caring for your line: firstly you must keep the line very clean and you must not touch it unless you have washed your hands thoroughly. Secondly, you must be very careful never to pull or tug on the line as it is possible to pull it out. Otherwise you may do all the things that you normally do. The wounds must be kept clean and dry for 10 days but after that you may shower. A bath carries a higher risk of infection, and although some patients do bathe and swim, please discuss this with your nurses.

Complications and problems

Risks with these lines are very small in comparison with the considerable benefits that they bring. Difficulties associated with inserting the line are rare. The most common problems seen once the line is inserted are blockage and infection. Both these problems can be minimised by careful attention to cleanliness and efficient flushing of the line. If you are ever in doubt about your line, it is always advisable to give it an extra flush and to contact the hospital. I discourage other people flushing a patient's line simply because we have experienced blocked lines when such arrangements have failed. You will be given a sheet telling you when to flush your line (click here for a copy for adults or children), which can be as infrequent as once a week. Patients who really do not want to flush their own lines are best advised to have a port which will last for many weeks without flushing.

Fees

As an anaesthetist I sedate my own patients so if you are an adult paying your own account you will not incur the additional costs of a separate anaesthetist.

If you are claiming on a UK insurance policy your insurer will pay separate amounts of benefit for the various parts of the procedure such as the consultation, the insertion and the imaging. Each insurer has a different system so although we charge all patients the same amount the way it has to be made up varies. We will be happy to provide a quote for you and assist you. We have agreed prices with many of the insurers, although some companies have recently reduced their benefits.

Please obtain a quote by completing our form. If you are not resident in the UK and do not have a letter of guarantee we will ask you to pay on admission. You can pay on line at www.anaesthesia.limited

 
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