Why Long lines and Central lines are used in New- Born babies?

During this time a preterm baby in the neonatal intensive care unit, which is where babies are born early, have health problems, or a difficult birth they go to the hospital’s NICU unit. Preterm babies need more calories, proteins, and other nutrients than a full-term baby. These extra nutrients that a preterm baby would require would be given as intravenous (IV) fluid through a vein. This fluid is called parenteral nutrition. IV fluids can be given through a standard drip (a 2 to 3cm plastic tube inserted into a vein usually in the baby’s arm or leg).

However, these drips are not so effectives, the disadvantage of this are:

• The IV fluid is an irritant to small veins and the veins are usually damaged
• The skin can be damaged by the irritant PN fluid.
• Re-siting drips can be distressing for the baby.
• Small veins get used up.

 

To avoid these disadvantages, we introduce a more effective and less disturbing technique:

The Long Line

What is the long line technique?

The Long Line is a fine plastic tube of 15 – 30 cm in length that is threaded into one of your baby’s veins in the arm, leg, or scalp to reach a point where the vein becomes much larger, usually just outside the heart.

 

Why this way is more effective?

This way the PN and drugs can be given more easily through this line and because it flows into a larger vein the risk of damage to the vein is much reduced. A long line can stay in place for several weeks, which reduces the number of times your baby needs to have a drip inserted. This way the baby would be less distressed from changing several of times.

 

What is the Technique of The Long Line?

Percutaneous lines are inserted under sterile conditions in the neonatal unit. The technique is very similar to inserting a standard drip but can be technically difficult and may take up to an hour to do. It is not usually a painful procedure, but we do give a small amount of 20% glucose into the baby’s mouth as this has been shown to be a very effective form of pain relief in babies. Sometimes, it can take a few attempts before a line can be sited.

On occasion, when we have not been able to get IV access using a percutaneous line, we may need to ask the Paediatric Surgeons to insert a central line through a small operation. This line is called a surgically inserted central line, often referred to by the trade name “Broviac® line”. These lines are inserted under a general anaesthetic. A small cut about 1cm long is made in the baby’s neck and one of the big veins located. A tiny hole is made in the vein and the line inserted under X-ray guidance to sit just inside the baby’s heart. This line is ‘cuffed’ to help hold the line in place, reducing the risk of it being pulled out accidentally. Because the line becomes attached to the baby’s tissues just under the skin it will also need to be removed surgically. To avoid a very rare complication of line inserted too far into the heart and fluid leaking around the heart, all lines are checked by X-ray after insertion prior to the use of PN.

 

How to reduce the risk of infections whilst carrying out this procedure:

• To reduce the risk of infection, the lines must be accessed in a sterile manner when changing IV fluids and giving medications.
• The line should also be carefully handled during nappy changes and other cares to avoid contaminating the outside of the line with a dirty nappy or hand. If this happens, please inform the nurse looking after your baby who can advise you if anything extra needs to be done.
• The dressings will often start to peel off around the edges. If the dressing has peeled off to the extent that the line is at risk of being exposed or the area under the dressing looks moist or dirty, the dressings will need to be changed.

 

What would be the possible complications of long and central lines?

Most babies do not have any complications but sometimes problems can occur, including:

• Misplacement: As the line is very thin and soft, the long lines can sometimes follow unusual routes. This cannot be detected except through X-rays. If the X-ray shows that the line is not placed in an optimal position, it may have to be removed or used with restrictions. The medical and nursing team will advise you on this.
• Infection – The baby becomes unwell, has a temperature and may be quieter than usual. If infection is suspected, blood tests are done, and antibiotic treatment started. If the baby does not improve it may be necessary to remove the line. Page 3 of 4
• Accidental removal – This is more likely to happen to percutaneous lines, which are only held in place by dressings and adhesive tapes. In surgical lines, once the cuff has become stuck in place (at 10 days) accidental removal is uncommon.
• Blockage – Lines may become blocked with a blood clot. Sometimes the line can be unblocked but often it will need to be removed and a new line inserted.
• Vein damage – Damage to veins can occur from PN.
• Fluid leaking into the heart – This is a very rare complication. The line may damage the wall of the heart and PN fluid may leak around the heart. This can prevent the heart from working normally. To avoid this complication all lines are checked by X-ray after insertion prior to the use of PN.
• Dislodged line: A piece of the line can break off and get lodged in one of the vessels further downstream. This can require a further procedure to retrieve the broken off line. This is exceptionally rare.

 

However most of these possible complications of the Long line and Central lines can be avoided if the procedure is carried out by a professional.

 

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