What is a central venous line?

A central line is a long fine catheter with an opening (sometimes multiple openings) at each end used to deliver fluids and drugs. The central line is inserted through the skin into a large vein that feeds into a larger vein sitting above the heart, so that the tip of the catheter sits close to the heart. There are several veins that are suitable for access, and the line may be inserted above or below the collarbone, on the side of your neck, in your groin or at the front of the elbow. The actual skin entry site depends on which vein is used. The line that is inserted at the elbow is called a PICC (Peripherally Inserted Central Catheter), and the lines that enter the shoulder or neck are called Central Venous Lines.

These pictures were sourced from Connection (LWW)

When the line is not in use, a plastic cap and a clamp to prevent leaking of blood close any part of the line that sits outside the body. The central line is tied in place with sutures (stitches) and can be left in position for a few weeks. A PICC will sometimes be secured with a “Stat lock” device  (ie without stitches), and can be left in position for several weeks to months as long as it does not become infected.

 

Why do I need a central line ?

Central lines are used to give fluids, blood products, chemotherapy and other drugs (such as antibiotics) directly into the bloodstream. Many of these drugs and fluids are not suitable to be given through smaller veins in the hand and forearm because they are very irritating to the lining of the veins, and would soon cause small veins to form blood clots and stop working. Central lines can sometimes be used to take repeated blood samples, thus reducing the number of repeated needle stabs in your arm.

 

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Are there any alternatives to a central line?

Most fluids and drugs (such as antibiotics) can be given through a smaller intravenous line into small veins of the hand or forearm, but these lines do not generally last long, and will need to be changed every 2 or 3 days. Some drugs and fluids (such as liquid food in the form of TPN ‘total parenteral nutrition’) can only be given through a central line.

 

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How is it put in ?

A doctor or a nurse specialist puts in the central line. They will explain the procedure to you, and will usually also attach a heart monitor to you while they put in the line. Sometimes you may be given sedation so that you are drowsy and relaxed during the procedure.

These are generally the things that happen during the line insertion:

• The area of skin where the line will enter is cleaned and draped with sterile towels;
• A local anaesthetic injection is used to numb the skin;
• The vein is located with a needle;
• A wire is passed through the needle to sit in the vein;
• The needle is removed, and the central line is then passed over the wire into the vein;
• The wire is then removed, and the line is stitched to the skin; and
• Sometimes a little tunnel is made under the skin for the line to pass through before it exits the skin, and this helps protect the line from infection.

A PICC is also inserted in a sterile fashion.

• A tourniquet is applied to the arm and the area is cleaned and draped;
• Local anaesthetic is injected into the skin near the vein;
• A cannula is then inserted into the vein, the needle is removed, and the tourniquet is released;
• A wire is inserted through the cannula and further into the vein;
• A larger catheter is then inserted over the wire to enlarge the skin opening, and to hold the vein open;
• The wire is removed and all that remains in the arm is the catheter;
• The PICC is then thread up the arm vein through the catheter to a previously measured level; and
• The PICC is then secured with a Stat lock or dressing.

The injection of local anaesthetic is usually the part of the procedure that causes the most discomfort. Once the needle or cannula is sitting in the vein the remainder of the procedure is not painful. Some minor bleeding may be seen at the insertion site on the first day.

A chest X-Ray is taken to see where the tip of the line is sitting in the vein.

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What are the risks of central lines?

As with most procedures there is a small risk of complications.

• Infection- is possible with any line, central or otherwise, and the risk increases with the age of the line. About one line in 20 will become infected. The signs of infection include redness, swelling and tenderness around the line as it enters the skin and fever or chills. If a line infection has occurred, usually the line has to be removed.
• Accidental puncture of the lung. This allows air to leak in the chest and sometimes needs a tube to be placed to drain off air. This happens to about 1 in 200 patients with lines that are inserted above or below the collarbone.
• The line tip in the vein is not in the correct position. About 1 in 20 patients need to have the catheter adjusted to a better position.

Accidental puncture of the artery that may cause bleeding. About 1 in 20 patients might have a nick in the artery, but this usually heals by itself as long as the blood clots normally. This is why your blood count and blood clotting are tested before the line is inserted.

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Keeping the line clean

Prevention of infection is an important consideration.  For this reason touching to central line is discouraged and anyone who does must wash their hands first. The skin exit site must be kept clean and dry. A transparent dressing is generally used over the exit site and is changed regularly (every three to four days or as needed).  Each end of the line needs to be flushed regularly to prevent the line becoming blocked, and sometimes an injection of heparin is given into the line to prevent blood clots causing a blockage.

It is recommended that you take showers rather than baths, because the line and skin exit site are not submerged in water. 

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Publication Information

Central venous lines - Procedure Version 1 (Author: Dr Louise Cole, Intensive Care Specialist, Nepean Hospital Penrith NSW)

First Published July 2007

Correspondence: ICCMU CNC

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The information contained on this page is general in nature and therefore cannot reflect individual patient variation.  In addition it reflects Australian intensive care practice which may differ from other countries. It is meant as a back up to specific information which will be discussed with you by the Doctors and Nurses caring for your loved one.  ICCMU attests to the accuracy of the information contained here BUT takes no responsibility for how it may apply to an individual patient.  Please refer to the full disclaimer.