Central Venous Catheter

What is a central venous catheter?

A central venous catheter, also called a central line or CVC, is a device that helps you receive treatments for various medical conditions. It’s made of a long, thin, flexible tube that enters your body through a vein. The tube travels through one or more veins until the tip reaches the large vein that empties into your heart (vena cava).

Thus, your CVC’s tip is located in your vena cava. The other end is located just above or below your skin somewhere on your chest, usually on your right side. If it’s on the outer surface of your skin, it’s called a hub. You can see and feel the hub since it’s outside your body. If the other end is underneath your skin, it’s called a portal or reservoir. You can see and feel a small (quarter-sized) bump below your skin, but it’s not as noticeable. The hub or reservoir is the access point for your treatment.

A CVC allows your provider to access your bloodstream easily, reducing the need for many needle sticks into your vein. So, a CVC is ideal for people who need long-term medications, fluids, blood draws or blood transfusions. People who need emergency care or short-term treatments also benefit from CVCs.

Central venous catheter vs. intravenous catheters (peripheral IVs)

Central venous catheters and intravenous catheters (also called peripheral IVs) both provide treatments and both devices enter your body through a vein. But they have three main differences:

• Where they enter your body.
• How big they are.
• How long they can stay in your body.

Central lines and peripheral IVs enter your body through different veins. Central lines enter a large vein in your chest, neck, arm or groin. It’s usually a deep vein that’s not close to the surface of your skin. Peripheral IVs enter a vein close to your skin’s surface in your hand or arm.

When it comes to size, central lines are longer and have a bigger tube. That’s because they need to travel farther to reach their destination. Some central lines have more than one tube. These are called double or triple lumen catheters. They can accommodate different types of medicine in complex situations.

When it comes to duration, central lines can stay in your body longer than peripheral IVs. You usually need to change peripheral IVs every few days. But some types of central lines can stay in for weeks or many months.

Who needs a central line?

Central lines help people in many different medical situations, including people who need:

• Blood or platelet transfusions.
• Chemotherapy.
• Fluids or blood in an emergency situation (like hypovolemic shock).
• Frequent blood draws.
• Hemodialysis.
• Long-term antibiotics.
• Nutrients delivered directly into their blood (if their digestive system isn’t working properly).
• The ability to receive medications at home.
• Vena cava filter placement.

Providers also use CVCs during some medical tests.

What are the different central venous catheter types?

Central venous catheters come in many forms. These include:

• Non-tunneled central venous catheter: This type of CVC is appropriate for short-term access to your vein (less than two weeks). Your provider uses a needle puncture to access a vein in your neck, groin or upper chest. Your provider guides the catheter tip into your superior vena cava.
• Peripherally inserted central catheter (PICC): A PICC line is similar to a non-tunneled CVC. But your provider uses a needle puncture to access a vein in your upper arm instead of your neck or chest. Your provider threads the catheter through other veins until its tip reaches your superior vena cava.
• Tunneled central venous catheter: This type is appropriate for more than two weeks of access. Your provider surgically inserts the catheter into a vein in your neck or chest. The catheter “tunnels “under your skin for 8 to 10 centimeters and then exits through your skin in a different area of your chest. You may hear your provider call a tunneled CVC by its brand name. Common names are Broviac®, Hickman® and Groshong®.
• Subcutaneous (implanted) port: A port is appropriate for long-term access of at least three months. This type doesn’t exit through your skin at all. Your provider surgically implants it so that it’s completely within your body. The hub (catheter access point) is very close to the surface of your skin. So, your provider can puncture your skin with a needle to access the hub for your treatment. Your provider may call this type of catheter an implantable venous port or a Port-a-Cath.

Your provider will tell you which type of CVC you need. It depends on your specific medical needs and how long you need the catheter.

Who performs a central venous catheter placement?

A healthcare provider called a proceduralist performs placement of central lines. Proceduralists are physicians who specialize in certain medical procedures.

How common are central venous catheters?

Central line placement is a common procedure. Millions of people receive a central venous catheter every year.

What are common insertion sites for a central venous catheter?

Three common access points for CVC placement include your:

• Internal jugular vein: Located in your neck.
• Subclavian vein: Located in your upper chest.
• Common femoral vein: Located in your groin.

PICC line access points include your basilic vein and cephalic vein, both located in your arm.

Each insertion site has advantages and disadvantages. Your provider will choose the best insertion site based on your condition and needs.

What happens before a central venous catheter insertion?

Your provider will explain the procedure to you, including its benefits and risks. You may ask any questions you have. Your provider will then ask for your consent to perform the procedure. In some emergency situations, this conversation isn’t possible.

Your provider will help you get into the proper position, which depends on the vein your provider needs to access. You’ll lie on your back, either completely flat or at a slight angle so your feet and legs are raised higher than your chest. Your provider will connect you to monitors that check your vital signs.

What happens during this procedure?

The procedure varies depending on the type of central venous catheter you need. If you need a non-tunneled CVC or a PICC line, you’ll have a percutaneous procedure. This means your provider punctures your skin with a needle to access your vein and insert the catheter. Your provider will perform the following steps.

1. Clean the area on your skin where they’ll insert the needle.
2. Give you medicine to numb the area so you won’t feel pain, and a sedative to help you relax.
3. Insert a needle into your skin. The location will vary depending on the vein your provider chooses to use. Possible locations include your arm, neck, upper chest and groin.
4. Thread a wire through the needle and carefully move the wire forward in your vein.
5. Use a scalpel to make the needle puncture site a bit wider.
6. Thread a device called a dilator into the opening in your skin. This device helps create space for your catheter to enter and move through your vein.
7. Gently push the dilator further into your soft tissue.
8. Remove the dilator, and begin threading the catheter over the guidewire.
9. Move the catheter through one or more veins until the tip of the catheter is in the correct location. The tip will be in your vena cava, either above or below your heart.
10. Sew the outer end of the catheter in place against your skin, and apply a bandage to cover the area and keep it clean.

Throughout, your provider may use ultrasound imaging technology to guide the procedure.

For tunneled CVC placement and port placement, your provider will use similar techniques to access your vein. But there are some differences you can expect.

Tunneled CVC

Tunneled CVC placement requires a needle puncture plus surgery. You’ll receive local or general anesthesia to keep you comfortable.

Another main difference is that your catheter’s entrance and exit points are different. With a non-tunneled CVC or PICC line, the catheter leaves your body at the original vein access point. With a tunneled CVC, your provider chooses a different point where the catheter will leave your chest.

The catheter runs like an underground subway below your skin between the vein access point and the spot where it leaves your body.

Subcutaneous port

Ports are also tunneled catheters, but the difference is that no part of the catheter comes out of your body. It’s entirely under your skin. You need a needle puncture plus surgery, and you’ll receive general anesthesia.

Your provider will make a small incision in your chest, in the area where your port will stay. This area will be close to the vein access point. Your provider will create a small pocket of space in your tissue just below your skin. They’ll insert the port into the pocket and sew it securely into place. Finally, your provider will sew the incision shut and apply a bandage.

What happens after this procedure?

Your provider will check to make sure the procedure was successful. They’ll perform a chest X-ray to confirm your CVC is in the proper place and that there are no complications. Your provider will tell you when you’re able to return home and give you instructions for what to do at home.

Your provider will also tell you how long you need your catheter and when you can have someone remove it. The length of time varies based on your medical needs and the catheter’s purpose.

What are the advantages of a central venous catheter?

A central venous catheter has many advantages over peripheral IVs, including:

• Fewer needle sticks. A CVC allows your provider to access your vein many times without sticking your vein with a needle each time. This method protects your vein from damage. It may also make you feel more comfortable and less anxious.
• Less pain. A CVC reduces or eliminates the pain, discomfort or burning sensation some people feel from peripheral IV therapy.
• Long-term access. A CVC allows you to receive treatment for a long time without the need to constantly change your IV.

What are the possible complications of a central venous catheter?

The main complication of central venous catheters is infection. This is called a catheter-related bloodstream infection (CRBSI). It can occur during catheter placement or later on in your daily life. The risk for a CRBSI is higher if the catheter’s hub is outside your body, especially if you have a non-tunneled CVC or PICC line. The risk is also higher with more lumens in the CVC. Infection risk is lower for tunneled CVCs and ports.

Other complications that may occur during CVC placement include:

• Arrhythmia (typically bundle branch block or ventricular arrhythmia).
• Bleeding.
• Collapsed lung (pneumothorax).
• Damage to an artery or vein.
• Damage to your trachea.

Complications that may occur after your procedure include:

• Delayed bleeding.
• Narrowed vein (stenosis).
• Thrombosis.

Possible complications of central venous catheter removal include:

• Air embolism (gas bubble that blocks a blood vessel).
• Bleeding.
• Catheter fracture (part of the catheter breaks off inside your vein).

How should I care for my central venous catheter?

Your provider will tell you how to care for your catheter at home. It’s important that you follow these instructions to lower your risk of infection. You need to keep your CVC’s hub and the area around it very clean.

You may also need to visit your provider regularly so they can flush your CVC. This prevents blockages and blood clots.

When should I see my healthcare provider?

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

• Fever.
• Pain or tenderness near your port or hub.
• Redness or red streaks in the surrounding skin.
• Warm or swollen skin.
• Yellow or green drainage.

Also call your provider right away if your catheter looks like it’s getting longer. This may signal that it’s coming out of your vein. If your catheter falls out or you remove it by mistake, please contact your provider right away.

Your provider will tell you how often you need to come in for CVC maintenance. Be sure to call your provider any time you have questions or concerns.

A note from Cleveland Clinic

Central venous catheters provide life-saving treatments in many different medical situations. If you need a central line, ask your provider which type is best for you, and why. Also ask your provider about the benefits and risks of your procedure and how to care for your catheter at home.