What is a Central Venous Line?
Central venous line placement is the insertion of a catherter/tube through the neck or body and into a large vein that connects to the heart. There are a variety of catheter, both size and configuration. The type of catheter and location of placement will depend on the reason for it’s placement. There are many uses of these catheters. Central lines can be inserted with surgery or by more minimally invasive means, such as under x-ray guidance by an Interventional Radiologist.
Reason for Placement
The purpose of a central venous line is generally to provide a patient temporary or permanent venous access to administer medications, provide nutrition, perform dialysis, withdraw blood, and other functions. Some commonly encountered diseases that need lines include: kidney failure, bone marrow transplant, cancer, nutritional disorders, and blood disorders.
The procedure is relatively simple and safe. As with any invasive procedure, patients should not be currently taking medications which affect the ability of blood clotting (aspirin, plavix, coumadin, heparin, etc). If a patient is on any of these medications, they should notify the physician performing the procedure to determine what changes in medication administration should be made prior to line placement. In addition, some prescription medications may increase risks associated with anesthesia.
Prior to the line placement, the patient will meet with the physician and supporting staff to explain the procedure and evaluate any special conditions that may affect tube placement. It is important that you tell them if you have had previous central lines in your neck or arm, previous line infections, radiation, skin infections, bleeding problems or allergies (antibiotics, dye, lidocaine). All of these can affect your central line placement. The patient may be asked to have blood drawn to evaluate for any potential bleeding disorder. It is important that you do not eat or drink for 6 hours prior to the procedure.
Central venous line insertion can be performed by an interventional radiologist, or general surgeon. Interventional radiologists use x-ray and ultrasound guidance along with minimally invasive techniques to perform the procedure. This generally results in less complications and faster recovery time. It also allows the patient to avoid the need for general anesthesia (where the patient is place in a deep sleep). Interventional radiologists will use conscious sedation (the patient will be in a twilight sleep). Pain medication will be given as well in order to minimize any discomfort.
After the patient is given conscious sedation, the skin on the neck (generally the right neck is the chosen site) will be cleaned and ‘numbed up’. Then a small incision will be made on the neck. This allows passage of a small plastic tube/catheter into the vein. The inside of the tube is hollow. Most catheters are then tunneled underneath the skin and exit through a small incision made on the upper chest. One exception is an Infusaport, which remains underneath the skin of the chest. The procedure is performed while using x-rays to guide placement of the tube.
The procedure itself lasts approximately 30 minutes to 1 hour . Usually the patient does not require overnight hospitalization. The patient and their family will be instructed on care of the catheter and discharged after the sedative medication resolves.
The line is ready for use immediately once it is in place. Patients and their families are taught how to care for the line, recognize and prevent infection around the line, what to do if the line pulls out, and what normal activities can be continued.
There are few risks associated with this procedure. The main potential complications are infection, bleeding, air embolism, dislodgment of the line, and injury to an adjacent organ. You should report these complications if they are not controlled by the medications provided. Dislodgment of the catheter should be reported immediately.
If you elect to have this procedure done, please click «HERE» to print, read and sign the consent forms. The physician will go over the entire procedure with you during your appointment to answer any questions and address any concerns you may have.