Intravenous (IV) Central Line

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KEY POINTS

• A central line is a kind of intravenous (IV) line used to give medicines and fluids, and sometimes to take blood samples.
• Central lines are put into larger veins and do not need to be changed as often as lines in smaller veins.
• Keep the skin around the central line clean and dry at all times. Follow your child’s healthcare provider’s instructions for pushing or flushing fluid through the line to keep it from clogging up.

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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 or groin. Your child’s 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 or chemotherapy, for more than a few days. This can happen 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. They may be put in during an emergency at a hospital. 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.

Ask your child’s healthcare provider about the choices for treatment and the risks.

What are the different types of central lines?

The location and type of central line depends on:

• If the line is done as a planned procedure or in an emergency
• How long the line will be in place
• If your child has had a central line in the past and where it was placed

There are 4 main types of central lines:

• PICC line (pronounced “pick line”): The PICC line (peripherally inserted central catheter) has a long flexible tube 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.
• Non-tunneled catheter: The non-tunneled catheter usually is placed in a large vein in the neck, just below the collarbone, and sometimes in the groin. This is often used in emergency and some hospital settings so that healthcare providers can give medicines and fluids. To prevent infection, a bandage will be placed over the area where the catheter goes into the skin.
• 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 one end. The other end of the tubing is threaded through a vein under the skin into a large vein near the heart. The chamber is placed under the skin through a small cut made by your child’s 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?

• For an older child, follow your child’s provider's instructions about not smoking before and after the procedure. Smokers may have more breathing problems during the procedure and heal more slowly. It is best to quit 6 to 8 weeks before surgery.
• You child may or may not need to take regular medicines the day of the procedure. Tell your child’s healthcare provider about all medicines and supplements that your child takes. Some products may increase your child’s risk of side effects. Ask your child’s healthcare provider if your child needs to avoid taking any medicine or supplements before the procedure.
• Tell your child’s healthcare provider if your child has any food, medicine, or other allergies such as latex.
• 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 child’s healthcare provider is going to do. You have the right to make decisions about your child’s healthcare and to give permission for any tests or procedures.

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 through 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 hold it in place and 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 child’s healthcare provider will tell you how to keep it dry during baths or showers. Your child also must take care not to catch a PICC line on clothing. Ask your child’s 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 of 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 child’s 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 be made to remove it. Your child will be given a local anesthetic before the cut is made. Your child’s 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. Keep all appointments for provider visits or tests.

What are the risks of this procedure?

Every procedure or treatment has risks. Some possible risks of this procedure include:

• Your child may have problems with anesthesia.
• Your child may have infection or bleeding.
• 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.
• 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:

• Centers for Disease Control (CDC)
  https://www.cdc.gov/HAI/bsi/bsi.html

Ask your healthcare provider how these risks apply to your child. Be sure to discuss any other questions or concerns that you may have.