Intravenous (IV) Central Line

What is an intravenous central line?

An intravenous central line is a kind of intravenous (IV) line used to give medicines and fluids. It is a thin, soft, plastic tube called a catheter that is inserted through the skin and into a vein. It is usually put in the neck or chest just below the collarbone. Sometimes it is put in the arm. Your healthcare provider gently pushes the tube through the vein until the tip is in one of the large “central” veins near the heart. This is why it is called a central line or central venous catheter.

When is it used?

A central line may be used to give medicine, fluids, or nutrition for many days, weeks, or months. It is most often used when your child needs to receive fluids and medicine (such as antibiotics) for more than a few days—for example, after major surgery or for cancer treatment. IVs that are put into smaller veins need to be changed every few days to prevent infection. When your child has a central line, a new IV won’t need to be started every few days. Central lines are put into larger veins and don’t need to be changed as often. Using larger veins may also help prevent irritation and collapse of veins from some medicines. Your child may be able to go home with a central line and be given some medicines at home.

A central line may also be used to draw blood. Then your child won’t have to be poked with a needle each time a blood test needs to be done.

What are the different types of central lines?

The 3 main types of central lines are:

• PICC line (pronounced “pick line”): The PICC line (peripherally inserted central catheter) is a long flexible tubing that is inserted into a vein in the arm and then guided into a larger vein in the central part of the body just above the heart. The end of the catheter sticks out of the skin of the arm and has a special cap covered by a small bandage.
• Tunneled catheter: The tunneled catheter is put in through the skin in the chest just below the collarbone. One end of the tubing is threaded through a vein under the skin into a large vein near the heart. The other end of the catheter stays on top of the skin. To prevent infection, a bandage will be placed over the area where the catheter goes into the skin.
• Implanted port: The implanted port has an opening with a soft cap (port) on the end. The chamber is placed under the skin through a small cut made by your healthcare provider. Medicines or fluids are given with a needle through the skin and into the port. No tubes come through the skin. Each time your child gets medicine or fluids through the port, medicine may be given to numb the skin so that it doesn't hurt. Sometimes medicine may be given through the port without numbing.

How do I prepare my child for insertion of the central line?

• Some medicines (like aspirin) may increase the risk of bleeding during or after the procedure. Ask your healthcare provider if your child needs to avoid taking any medicine or supplements before the procedure.
• Your child may or may not need to take their regular medicines the day of the procedure, depending on what the medicines are and when they need to be taken. Tell your healthcare provider about all medicines and supplements your child takes.
• Follow any other instructions your provider gives you. Your child may need to stop eating and drinking for several hours before the procedure to keep from vomiting during the procedure.
• Ask any questions you have before the procedure. You should understand what your healthcare provider is going to do.

What happens during the procedure?

Before the catheter is inserted, your healthcare provider will clean your child’s skin and follow steps to prevent an infection. Your child will be given a local anesthetic to numb the area or medicine to help your child relax.

The catheter will be threaded though a needle into the vein. Your provider may use ultrasound and X-rays to watch the catheter as it is moved through the vein. X-rays may also be taken after the procedure to make sure the line is in the right position. When the catheter is in the right position, it may be stitched into place and covered with a clear bandage to prevent infections. If your child has an implanted port, your provider will make a small cut in the skin so the port can be placed under the skin. The cut will be stitched closed and covered with a bandage.

The procedure takes about 30 minutes not counting the time to prepare the skin and place the sterile drapes.

What happens after the procedure?

Whether your child is in the hospital or at home, there are 2 important steps to caring for a central line:

• It is important to prevent infections. Keep the skin around the central line clean and dry at all times. Wash your hands before and after touching the catheter area. Your healthcare provider will tell you how to keep it dry during baths or showers. You also have to take care not to catch a PICC line on clothing. Ask your provider what is recommended for wrapping the area to protect it.
• Fluid must be pushed through the line to keep it from clogging up. This is called flushing. An implanted port needs to be flushed every 4 to 6 weeks. PICC lines need to be flushed a couple times a week. The nurse or healthcare provider may flush the line while your child is in the hospital or healthcare provider's office. They may show you how to do it yourself at home. Be especially careful to follow your instructions for keeping all fluids and syringes sterile.

When the central line is no longer needed, your healthcare provider will pull the catheter out of the vein and then put pressure on the spot where it entered the skin to stop bleeding. If your child has an implanted port, a small cut will have to be made to remove it. Your child will be given a local anesthetic before the cut is made. Your healthcare provider will close the cut after the port is removed.

Ask your healthcare provider how to take care of your child at home and when your child can return to normal activities. Ask what symptoms you should watch for and what precautions you should take. Make sure you know when your child should come back for a checkup.

What are the risks of this procedure?

Your healthcare provider will explain the procedure and any risks. Some possible risks include:

• Anesthesia has some risks. Discuss these risks with your healthcare provider.
• If the catheter is inserted into a vein in the chest, the lining of the lung could be punctured. This could cause the lung to collapse. A collapsed lung would require another procedure to inflate the lung.
• Your child may have infection or bleeding.
• A clot may form around the tip of the catheter in the vein and block the catheter or block the vein and make the arm swell.
• Your child’s blood can be infected by the catheter if bacteria or other germs travel down the catheter and into the blood. To help prevent infection:
  • Your child’s healthcare provider will follow special steps to clean the skin or the port before giving medicines or drawing blood.
  • You and your child’s healthcare providers will keep the area around the catheter clean and check it often for infection.
  • You or your child’s provider will change the bandage around the insertion site when it gets dirty.

  You can get more information about catheter-associated infections from the Centers for Disease Control (CDC) Web site: http://www.cdc.gov/ncidod/dhqp/pdf/guidelines/BSI_tagged.pdf.

There is risk with every treatment or procedure. Ask your healthcare provider how these risks apply to your child. Be sure to discuss any other questions or concerns that you may have.