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A Central Line or Central Venous Catheter is a thin, soft plastic tube — like an intravenous (IV) line — that allows you to receive medicines and fluids, obtain blood tests and directly obtain cardiovascular measurements.
It is usually inserted into a large vein in your neck (internal jugular vein), chest (subclavian vein) or groin (femoral vein). It is then advanced to the main vein near your heart where blood flows quickly.
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Indications for the use of central lines include:
- Monitoring of the central venous pressure (CVP) in acutely ill patients to quantify fluid balance
- Long-term Intravenous antibiotics
- Long-term Parenteral nutrition especially in chronically ill patients
- Long-term pain medications
- Chemotherapy
- Drugs that are prone to cause phlebitis in peripheral veins (caustic), such as:
- Calcium chloride
- Chemotherapy
- Hypertonic saline
- Potassium chloride
- Amiodarone
Plasmapheresis
Dialysis
Frequent blood draws
Frequent or persistent requirement for intravenous access
Need for intravenous therapy when peripheral venous access is impossible
- Blood
- Medication
- Rehydration
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 anesthetic 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; v
- 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.
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.
- The use of ultrasound guidance during CV line placement has been demonstrated to significantly decrease the failure rate, complication rate, and number of attempts required for successful access.
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