Central Venous Catheter (Central Line)

A central venous catheter, also called a CVC or central line, is a long, flexible, plastic tube that sends medicines and other treatments into a large vein in the middle of your chest. It’s a type of intravenous (IV) line. But unlike peripheral IVs, which can only stay in place for a few days, a central line can remain for weeks, months or even years. Your healthcare provider places the central line during a minor procedure.

You may need a central line for:

• Blood or platelet transfusions
• Chemotherapy
• Fluids or blood in an emergency situation (like shock)
• Frequent blood draws to monitor a health condition
• Dialysis
• Long-term antibiotics
• Receiving nutrients

Central lines are very common. Each year, healthcare providers around the world insert about 27 million of them.

Types of central lines

Central venous catheters come in many forms. These include:

• Non-tunneled catheter: This type is for short-term access to your veins — up to three weeks. You’ll see one end of the catheter (its “tail”) hanging out from your skin, typically in your upper chest. The other end stays inside a large vein near your heart.
• Peripherally inserted central catheter (PICC line): This is a specific type of non-tunneled catheter that can stay in place longer — usually up to six months. The “tail” hangs out of your arm near the elbow crease.
• Tunneled catheter: Commonly called a Hickman™ or Broviac line™, this type can last months or years. It gets its name from how it “tunnels” just beneath your skin, like an underground subway. It leaves your body at a different spot from where it first went in.
• Implanted port: This is a specific type of tunneled catheter that can last for years. Your provider places it inside your body. You won’t see the line hanging out of your skin. But you may see or feel a slight bulge under your skin. Ports are commonly used for chemo.

Healthcare providers also describe central lines by how many channels (lumens) it has. Each lumen is a thin tube that connects to the main tube in your vein. You might hear these called single, double or triple lumen catheters. With more than one lumen, your provider can give you multiple medications at the same time.

How should I prepare?

There’s not much you need to do to prepare for CVC placement. Your healthcare provider will review your health history and medications list to make sure a central line is appropriate and safe for you. They may also do blood tests and imaging tests to get information that helps with the procedure — like how well your blood clots, and the location of your veins.

Your provider will let you know if you need to fast (avoid all foods and drinks except water) before your procedure.

What happens during central line placement?

The exact details depend on the type of CVC you’re getting. In general, a healthcare provider will:

1. Help you lie comfortably on your back
2. Connect you to monitors that check your vital signs
3. Clean any areas of your skin where they’ll insert a needle and, if necessary, clip hair there
4. Give you medicine to numb areas of your skin and/or put you to sleep
5. Use imaging (ultrasound and possibly fluoroscopy) to see your veins and guide the procedure
6. Puncture your skin with a needle at one or more points in your chest and/or arm to access your veins (these spots are commonly called “insertion sites”)
7. Insert the catheter and guide its tip to a large vein in your chest called the superior vena cava or inferior vena cava (depending on the insertion site)
8. Attach the catheter “tail” to your skin using special tape (for non-tunneled CVCs) or close any incisions with dissolvable stitches (for tunneled CVCs)

Central line placement usually takes about one hour. You can go home the same day unless you need to stay at the hospital for other reasons.

What are the potential benefits and risks of a central venous catheter?

A central line has many advantages over a peripheral IV, including:

• Fewer needle sticks: A CVC lets your provider access your vein many times without sticking it with a needle each time. This protects your vein from damage.
• Less pain: A CVC reduces or eliminates the pain, discomfort or burning sensation some people feel from peripheral IV therapy.
• Long-term access: A central line lets you receive treatment for a long time without the need to constantly change your IV.
• Medications: There are certain vasoactive medications (such as home inotropes) that you can only get through a central line.

Possible CVC complications include:

• Infection: This can happen in the skin around the catheter or in your bloodstream.
• Deep vein thrombosis (DVT): This is a blood clot that forms in a vein deep inside your body. Usually, DVT affects the legs. But central venous catheters are a known cause of upper-extremity DVT. This means clots form in veins in your arms or upper chest.
• Damage to an artery: An artery close to your vein may accidentally get poked or damaged during central line placement. This is rare due to the imaging guidance providers use during the procedure.
• Collapsed lung (pneumothorax): This is when the space between your lung and chest wall fills with air. It’s also rare.

What happens after central line placement?

Your healthcare provider will tell you when you can return home. They’ll also explain:

• How to take care of your central line — including how to clean the area to lower your risk of infection
• Any limits on physical activity
• How long the catheter will stay in

Central venous catheter removal

CVC removal is usually simpler and faster than placement. But you should never remove the catheter on your own. Only a healthcare provider can do this. For a PICC line, your provider will gently pull on the end of the catheter to remove it from your vein. For a port, a provider will make a small cut in your skin to remove the device.

When should I call my healthcare provider?

Call your provider immediately if you have signs or symptoms of a central line infection. These include:

• Fever
• Pain or tenderness where the line hangs out of your skin or above your implanted port
• Discolored skin (red, purple, brown or black), which may look like streaks of color
• Warm or swollen skin
• Yellow or green drainage

Also, call your provider right away if:

• The catheter looks like it’s getting longer (this may mean it’s coming out of your vein)
• The catheter falls out, or you remove it by mistake

Your provider will tell you how often you need to come in so they can check on your central line.

What are common insertion sites for a central venous catheter?

Common access points for central line placement include your:

• Basilic vein or brachial vein in your arm (for PICC lines)
• Internal jugular vein in your lower neck
• Subclavian vein in your upper chest
• Femoral vein in your groin

Rarely, healthcare providers use the femoral vein if no other insertion sites are available. But they avoid this, if possible, due to increased infection risk.