Niagara line (neck line) care

Information for patients

This leaflet answers common questions about caring for your central venous catheter. If you would like any further information or have any non-urgent worries, please do not hesitate to contact your named nurse or doctor.

What is a Niagara line?

The Niagara line (also called a temporary central line CVC) is a soft flexible hollow tube that is placed into a large vein, most usually in your neck. It is designed to stay in your body for 7 to 10 days. It can be used to extract stem cells, give you blood products, intravenous medications and take blood samples.

The line is maintained in place by stitches, which will be removed at the same time as the line when it is no longer needed. There is a plastic clamp on the line which must be closed when it is not in use. At the end of the line there is a cap or bung which will need to be changed weekly.

Caring for your central venous line

• Keep the dressing in place at all times. A transparent dressing will cover the exit site. This dressing will need to be changed at least weekly but sooner if it is starting to peel off, or if the wound looks mucky or is bleeding. This will be changed by ward nurses. During dressing changes, and when the line is being connected or disconnected, avoid breathing or coughing over it to reduce the risk of germs entering the bloodstream.
• Avoid sharp objects near your line. If you are staying in Addenbrooke's accommodation, please do not shave!
• Avoid getting the dressing wet. Take care to keep it dry even when showering; your hair should be washed over a sink.
• Never open the clamps or remove the end caps from the two tubes coming out of your line. These prevent air and germs from entering the blood stream.
• Avoid pulling on the catheter – this can be painful, and if the line gets dislodged you could bleed, delaying your treatment. Vigorous activity should also be avoided.

Using your line

The end of the line must be thoroughly cleaned with an antiseptic (chlorhexidine) wipe before it is used, and the bungs should be changed at least weekly. Anyone using your line should be trained and should be using a special technique called an ‘aseptic non-touch technique'. Each lumen of your line needs flushing after use to prevent it from becoming blocked.

Please note: dressing changes, line flushes and bung changes are a sterile procedure. If you experience a cold and shivery feeling during or after your line flush, please report it to your treating team.

Will it be painful afterwards?

Once the local anaesthetic wears off you may find the procedure site tender and uncomfortable – this is normal, and should only last a day or two. It is fine to take simple painkillers such as paracetamol if required, as per haematology guidance.

Can I have a bath/ shower?

You can shower with a line in, or sit in a bath, but the line must not be submerged. Do not apply any creams or lotions to the insertion site or the line. The line, insertion site or bungs must not be submerged because of the risk of infection.

What happens if something is wrong?

Serious complications that may occur when the line is in place

Line falls out

In the unlikely event that the line falls out, you should immediately apply pressure to the site to stop any bleeding using a gauze and a dressing in the pack provided. Seek help by calling 999.

Bleeding from around the exit site

Apply pressure to the exit site and call the 24 hour advice line: 01223 274225.

Line clamps break/ tubing becomes cut or punctured

Clamp the line as soon as possible with the clamps provided, above the break. Please call the 24 hour advice line: 01223 274225.

Other complications that may occur

Infection

If you notice redness around the line, a discharge from the entry site or if you have a temperature above 37.5 degrees, fever, chills or feel generally unwell, it could mean that you have an infection. Please call the 24 hour advice line: 01223 274225.

Signs of a blood clot

Pain, swelling or discomfort in your neck or arm on the side of the catheter insertion could be signs of a blood clot. Please call the 24 hour advice line: 01223 274225.

Blocked line

If the line becomes blocked, it may be difficult to aspirate blood or to inject through the line. In most cases, the line should not be used until the problem has been dealt with. Special clot-busting drugs can usually help.

Rare complications

Rarely, the line can irritate the heart and cause abnormal heart rhythms or cause fluid to build up in the sac around the heart. If you feel any palpitations, light-headedness, dizziness or shortness of breath it is important to seek immediate medical advice.

Occasionally, the line can become dislodged. If you notice that the line is farther out than normal, seek immediate medical advice.

You should not feel pain when the line is being used – if you do, then please report this; call the 24 hour advice line: 01223 274225.

How is the central venous catheter removed when it is no longer needed?

Before the removal you will need to lay flat, with the head of your bed tilted down and your legs raised as this prevents air entering in your bloodstream. Your nurse will put pressure on the site to prevent bleeding and an occlusive dressing will be applied. The dressing should remain in place for 48 hours.

Privacy and dignity

Same sex bays and bathrooms are offered in all wards except critical care and theatre recovery areas where the use of high-tech equipment and/or specialist one-to-one care is required.