Central Venous Catheters

Topic Overview

What is a central venous catheter?

A central venous catheter, also called a central line, is a long, thin, flexible tube used to give medicines, fluids, nutrients, or blood products over a long period of time, usually several weeks or more. A catheter is often inserted in the arm or chest through the skin into a large vein. The catheter is threaded through this vein until it reaches a large vein near the heart.

A catheter may be inserted into the neck if it will be used only during a hospital stay.

What is a central venous catheter used for?

Central venous catheters are used to:

• Give long-term medicine treatment for pain, infection, or cancer, or to supply nutrition. A central venous catheter can be left in place far longer than an intravenous catheter (IV), which gives medicines into a vein near the skin surface.
• Give medicines that affect the heart, especially if a quick response to the medicine is wanted.
• Give large amounts of blood or fluid quickly.
• Take frequent blood samples without having to "stick" someone with a needle.
• Receive kidney dialysis if you have kidney failure.

A central venous catheter can be left in place far longer than an intravenous catheter (IV), which gives medicines into a vein near the skin surface. Also, a central venous catheter allows a person to receive IV medicines at home.

What types of central venous catheters are there?

There are several types of central venous catheters.

PICC line. A peripherally inserted central catheter, or PICC line (say "pick"), is a central venous catheter inserted into a vein in the arm rather than a vein in the neck or chest.

Tunneled catheter. This type of catheter is surgically inserted into a vein in the neck or chest and passed under the skin. One end of the catheter remains outside the skin. Medicines can be given through an opening in this end of the catheter. Passing the catheter under the skin helps keep it in place better, lets you move around easier, and makes it less visible.

Implanted port. This type is similar to a tunneled catheter but is left entirely under the skin. Medicines are injected through the skin into the catheter. Some implanted ports contain a small reservoir that can be refilled in the same way. After being filled, the reservoir slowly releases the medicine into the bloodstream. An implanted port is less obvious than a tunneled catheter and requires very little daily care. It has less impact on a person's activities than a PICC line or a tunneled catheter.

Can complications result from the use of a central venous catheter?

Possible complications from the use of a central venous catheter include:

• Bleeding, caused by inserting the catheter into the vein. But this is usually mild and will stop by itself.
• Infection, requiring treatment with antibiotics or removal of the catheter.
• Blood clots, which can form in blood vessels, especially in the arms.
• A blocked line. This can happen from a blood clot or from something else getting stuck in the line. Regular flushing of the catheter can help keep the line clear. Preventing infections and making sure the catheter is in place can also help keep the line clear.
• Kinking of the catheter. A twisted or kinked catheter must be repositioned or replaced.
• Pain. You may experience pain at the place where the catheter is inserted or where it lies under your skin.
• Collapsed lung (pneumothorax). The risk of a collapsed lung varies with the skill of the person inserting the catheter and the site of placement. It is most likely to happen during placement of a catheter in the chest, although the risk is small.
• Shifting of the catheter. A catheter that has moved out of place can sometimes be repositioned. If repositioning does not work, it must be replaced.

How can you care for a central venous catheter at home?

Your nurses will teach you how to take care of your catheter. You will learn how to change the dressing and flush your catheter. Call your doctor if you have questions or concerns.

You can take steps at home to care for your catheter:

• Always wash your hands before you touch your central line.
• Try to keep the exit site dry. This can help prevent infection. When you shower, cover the site with waterproof material, such as plastic wrap. Be sure you cover both the exit site and the central line cap(s).
• Fasten or tape the central line to your body to prevent it from pulling or dangling. Avoid bending or crimping your central line. And wear clothing that doesn't rub or pull on your central line.

When should you call for help?

Call 911 anytime you think you may need emergency care. For example, call if:

• You passed out (lost consciousness).
• You have severe trouble breathing.
• You have sudden chest pain and shortness of breath, or you cough up blood.
• You have a fast or uneven pulse.

Call your doctor now or seek immediate medical care if:

• You have signs of infection, such as:
  • Increased pain, swelling, warmth, or redness.
  • Red streaks leading from the exit site.
  • Pus or blood draining from the exit site.
  • Swollen lymph nodes in your neck, armpits, or groin.
  • A fever.
• You have a fever over 100°F (38°C), or you have chills.
• You have swelling in your face, chest, neck, or arm on the side where the central line is.
• You have signs of a blood clot, such as bulging veins near the catheter.
• Your central line is leaking.
• You feel resistance when you inject medicine or fluids into your line.
• Your central line is out of place. This may happen after severe coughing or vomiting, or if you pull on the central line.

Watch closely for changes in your health, and be sure to contact your doctor if:

• You have any concerns about your line.