Patient education: Central line catheter insertion (The Basics)

What is a central line catheter? — 

A central line catheter, or "central line," is a special kind of IV. Sample brand names include Broviac, Hickman, Groshong, and Hohn. A central line is also sometimes called a "central venous catheter" ("CVC").

You might need a central line if you:

●Need to get medicines or fluids for a few weeks or months

●Need certain medicines that smaller veins might not be able to handle

●Are taking medicines that need to be given through an IV, and the veins in your arm are very hard to find

With a central line, you can get the nutrients, fluids, blood, and medicines you need. The medical staff might be able to draw blood for lab tests through the central line. You might also need fewer needle sticks for IVs or blood tests.

A central line is inserted through the skin in the chest. Most central lines for long-term use are "tunneled" under the skin. This means the point where the catheter enters the vein is away from where the catheter exits the skin. The information below is about tunneled central lines.

There are other types of central venous catheters, such as a peripherally inserted central catheter ("PICC"). A PICC is inserted through a vein in the upper arm.

How is a central line different from a simple IV? — 

A simple IV only goes a little way into a blood vessel. Most last only for a few days.

A central line is a long, thin, flexible tube, called a "catheter." A doctor or nurse places the central line through the skin in your chest. They insert it into a vein, and then move it forward until the end of the catheter is in the large vein near your heart (figure 1). A central line can stay in place for weeks or months.

A central line can have 1, 2, or 3 "lumens" with ends called "hubs." These stay outside the body and are covered with caps. You can go home from the hospital with some kinds of central lines.

How do I prepare for central line placement? — 

The doctor or nurse will tell you if you need to do anything special to prepare. Before the procedure, the doctor will talk with you about the central line.

Your doctor will ask about your "health history." This involves asking about any health problems you have or had in the past, past surgeries, past central lines, and any medicines you take. Tell them about:

●Any central lines you've had in the past, including PICCs, no matter how long ago – Tell them also if there were any problems with your lines, like blood clots.

●Any implanted electronic devices like a pacemaker or "ICD"

●Any kidney problems and plans for future dialysis

●Any medicines you are taking – This includes prescription and "over-the-counter" medicines, plus any herbal supplements. It helps to write down and bring a list of your medicines, or bring a bag with all your medicines with you.

●Any allergies you have

●Any bleeding problems you have – Certain medicines, including some herbs and supplements, can increase the risk of bleeding. Some health conditions also increase this risk.

●If you cannot have medicines to make you numb – These medicines are used when you have stitches or dental work (sample brand names: Xylocaine, Novocain).

Before the procedure, your doctor will do an exam. They might also do an imaging test called an ultrasound to look at your veins. This creates pictures of the inside of the body.

You will also get information about:

●Fasting – This means not eating or drinking anything for a period of time. Whether you need to fast, and for how long, depends on if you will need medicines to help you relax during the procedure.

●Lowering the risk of infection – The doctor or nurse might need to trim your body hair before the procedure. They might also have you wash the area with a special soap.

●What help you will need when you go home – For example, you might need to have someone else bring you home or help you care for your central line at home.

Ask the doctor or nurse if you have questions or if there is anything you do not understand.

What happens during a central line placement? — 

Usually, doctors insert a central line in an operating room. When it is time for the procedure:

●You will get anesthesia medicines. This is to make sure you do not feel pain during the procedure.

●The doctor will clean your skin with a special soap, and cover your body with sterile towels and sheets. They will wear face masks, hats, gowns, and gloves to help prevent infection.

●The doctor will make a small cut ("incision") near where the catheter will go into your vein. This is the "insertion site." They will make another small incision lower on your chest. This is the "exit site." Then, they will make a small tunnel under your skin between the 2 incisions.

●They will place a needle through the insertion site, and use a wire to insert the catheter into your vein. They will use ultrasound to help guide them. Then, they will remove the needle and wire.

●They will pull the catheter through the tunnel, and stitch the end with the lumens to the exit site.

●They will use fluoroscopy (a moving X-ray) to guide the central line into a large vein near your heart.

●When the procedure is done, the doctor or nurse will "flush" the central line with a sterile fluid. Then, they will place a cap on each lumen.

●In some cases, doctors will place a:

•Small sponge disc to help prevent infection

•Device to help hold the catheter in place

●The procedure takes 45 to 60 minutes.

What happens after the central line is placed? — 

The doctor or nurse will do an X-ray to make sure the tip of the catheter is in the right place before the central line is used. If you are in the hospital, having a central line will not make your stay longer.

What are the risks of a central line? — 

The doctor or nurse will talk to you about all the possible risks and answer your questions. Possible risks include:

●Infection

●Blood clot

●Bleeding

●The central line breaking, leaking, or not working

●The tip of the central line moving out of place

●A collapsed lung (called "pneumothorax")

What else should I know? — 

If you are going home with a central line, you might need a family member or friend to help you care for it. Some people have a home health nurse come to their home to help with this.

More on this topic

Patient education: How to care for a central line catheter (The Basics)
Patient education: Lowering the risk of a central line infection (The Basics)
Patient education: Central line infection (The Basics)
Patient education: Parenteral nutrition (The Basics)