Central Line Course

A central line is a special form of a catheter, or tube, which emergency or other medical personnel may need to insert into a large vein in order to complete a variety of medical procedures. The central line procedure and device are referred to in many different ways, sometimes referred to as a central line, Hickman line, or central venous catheter, among other reference terms. A physican may choose to utlize a central line because it can handle a higher volume of fluids, extract blood with greater ease, and can remain inserted longer than a standard peripheral intraveneous line.

The basic concept is that a tube is inserted through the skin and into a deep vein. The exposed portion of the tube contains multiple IV ports that are capped. When accessed, the ports provide medical personnel with direct access to the vein, allowing for administration of fluid, emergency medications, hyperosmolar solutions (e.g., TPN) and can be used as access for insertion of devices such as pulmonary artery catheters or temporary transvenous pacemakers. When closed, the cap forms an airtight seal which prevents germs or dirt from entering the tube and causing infection or an air embolus.

With a procedure as invasive as a central line, infection is one of the worst complications that can occur. Not only from germs entering through the tube itself, but also from around the point of insertion. As a result, the insertion area needs to be meticulously cleaned and cared for. Other complications of central line placement include deep venous thrombosis, pneumothorax (for subclavian lines and internal jugular lines), hemothorax (for subclavian lines), hematomas and inadvertent cannulation of arteries.

The risks associated with central line placement are very similar to the risks associated with other similar or related procedures such as an internal jugular line placement. These risks include:

• Central line-associated bloodstream infections (CLABSI)
• Pneumothorax
• Artery injury
• Hematoma
• Deep venous thrombosis

A central line catheter may be inserted if a patient has veins which are exceptionally difficult for medical personnel to access.

Central venous catheter may be placed in patients who are to receive ongoing chemotherapy.

Patients receiving therapeutic treatments such as blood or platelet transfusions.

If it’s an emergency and you’re not already admitted to a medical facility, then contact your local emergency dispatch, or go to the nearest ER or emergency medicine facility. For non-emergency issues, contact your primary care physician who will advise you of what to do.

Symptoms of infection may include swelling or pain around the insertion point or fever. In some cases a Central Line may cause a blood clot in the vein containing the line. This may be indicated by swelling or soreness, chest pain, chest tightness, or shortness of breath.

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