Getting a Central Line and Entering the Hospital

Before you begin treatment with a bone marrow or cord blood transplant (also called a BMT), you will have a pre-transplant health evaluation and meet your transplant team. If you do not already have one, you will get a central line put in to be used throughout your transplant treatment. You will probably also be admitted to the transplant hospital.

Getting a central line

You will get many drugs before and after your transplant. To make it easier to get drugs into your bloodstream, doctors use a central line. A central line is a tube that is surgically inserted into a large vein in the chest, just above the heart. There are many types of central lines and they may be referred to by different names. These include central venous catheter, Hickman catheter, Broviac catheter and others.

You will have your central line put in before you start your pre-transplant treatment (preparative regimen). You may have it put in when you enter the hospital or a few days or weeks before then.

The outside end of the central line may have two or three ports. IV tubes can be connected to these ports so that bags of drugs or blood products can be infused into a vein. With a central line you will not need to have a needle stick each time you get IV drugs. When you receive your transplant of bone marrow or cord blood cells, they will be infused through your central line as well. The central line may also be used to draw blood from the vein for blood tests.

Your medical team will use the central line often while you are in the hospital. You will probably still have the central line for a time after you leave the hospital. In the hospital, your medical team will keep the central line clean to try to prevent infections. You or your caregiver will continue to clean the central line if you still have it when you return home.

Signs of central line infection

It is important to tell your doctor if there are any signs of infection around your central line. Some signs of infection include:

Fluid draining around where the tube enters your body
Pain, redness or swelling along the tube under the skin
Problems flushing the line or getting drugs or blood through the line
Chills after flushing the line
Fever

Entering the hospital

Before you begin your pre-transplant treatment (preparative regimen), you will meet the members of your transplant team. Many doctors, nurses and other specialists will be part of your care during transplant. You will meet many of them when you have your pre-transplant health evaluation. A transplant coordinator or nurse coordinator will explain what to expect at the transplant center. You will have a chance to ask about hospital policies, such as rules for visitors, where you can do laundry and whether computers are available for your use.

To help you keep track of what you may need to do before your transplant treatment begins, see:

Length of time in the hospital

Many patients who have a transplant using an unrelated donor or cord blood unit are in the hospital for several weeks or months. However, the length of your hospital stay will depend on your transplant center, your treatment plan and how quickly you recover after transplant. Some transplant centers admit patients before starting the preparative regimen while others wait until the day of transplant. At some transplant centers, patients who receive reduced-intensity transplants are not admitted to the hospital at all unless they have complications that require hospitalization. Transplant centers also vary in how soon they discharge patients from the hospital after transplant.

Infection prevention in the hospital

When you are admitted to the hospital, you will be in a special section or unit for transplant patients. Especially in the first weeks after your transplant, you will be at a higher risk for infections. Your hospital will have a plan to reduce your chances of getting an infection. At some transplant centers, you may stay in an isolation room where air is filtered to remove germs. Visitors will need to wash their hands before and after each visit. Some transplant centers also require visitors to wear masks over their noses and mouths. Anyone who is sick will not be allowed to visit you. Some centers do not allow young children to visit.

For more information about your risk of infection and other transplant complications and how your transplant team will manage them, see:

Being part of research NMDP studies

Before you begin your transplant treatment, you may be asked to be part of one or more clinical trials or research studies. Most transplant centers have many clinical trials in progress. The NMDP may be involved in some of these trials.

The NMDP and its research affiliate, the Center for International Blood and Marrow Transplant Research (CIBMTR), collect and study data on transplant patients' results. The goal is to learn how to improve transplants. The NMDP asks patients who receive cells for transplant through the NMDP to sign consent forms allowing the NMDP to collect medical information:

On the day of transplant
At 100 days after transplant
At six months after transplant
From annual follow-up visits

This information is collected only if you agree. The NMDP and transplant doctors worldwide study these data to learn which transplant procedures are working best. These studies maintain donor and patient confidentiality. Researchers do not learn your name or the private details of your transplant. They look at the combined data from many patients. What they learn can help more patients get transplants, have lower risks of complications and recover more quickly. To learn more about the NMDP's research affiliate, the CIBMTR, visit www.cibmtr.org.

Getting a Central Line and Entering the Hospital