Why Would I Need A Central Line?
Often, using the veins in your arms and the hands may work quite well for your intravenous needs, but if you have any of the following, you may wish to ask your healthcare provider about the possibility of a central line catheter (also called a venous access device):
- Are extremely anxious or phobic about having needles inserted.
- Have veins which are difficult for nurses and technicians to get into to start IV's.
- Are getting chemotherapy which has to be given as a continuous infusion (over more than one hour).
- Anticipate many months of chemotherapy treatments.
- Would just prefer NOT to have to have IV's started in your arms.
- Have a physician or nurse who recommend it.
- Are receiving chemotherapy intravenously (by the vein) which often requires multiple "needle sticks."
- Need frequent drawing of blood samples during your treatment.
- Are receiving other intravenous therapies such as blood or platelet transfusions and antibiotic therapies.
What Exactly Is a Central Line?
There are a variety of different types of central lines (also called catheters) that can be left in your body for varying lengths of times. We will discuss the ones that can be left in for months at a time.
Implantable Ports, Port-A-Caths, Mediports
The manufacturers name these devices which have been in common use for about 20 years. They are made up of a small "port" made of stainless steel, titanium, plastic, polysulfone or a combination. This port holds a small amount of an anticlotting material (heparin) to keep it from clotting off from the body's natural defenses. It is put entirely under your skin, generally in the upper chest surgically. A small incision is made by a surgeon skilled in the procedure after you are given local anesthesia. A second small incision is made nearby to attach the port to a catheter. The catheter is invisible inside your body and is threaded in the large vein that leads to the area near the heart. The tip of the catheter rests just above the heart's right atrium in the large vein called the vena cava. A few stitches are left in place until your skin completely heals over. Healing is very quick and the port can be used by your doctor or nurse right away.
The insertion procedure takes about 30 minutes and has little risk attached. Your physician will review the procedure and the risks with you before the port is placed. Ask your nurse for more detailed information about the port and its care to take home with you.
Using The Port
Caregivers with special training are the only ones who should be using your port. A special needle, called a "non-coring" needle is used in the port. If your IV is to be left in place, this needle is pre-bent to a 90 degree angle, and taped and secured in place and attached to the IV that is running.
If the port is being used only to draw labs, then the needle may be a straight one and will be removed after the blood is drawn and put into the lab tubes. Your port is then flushed with heparin before the needle is removed. A small Band-Aid is usually applied over the port needle site in case a few small drops of blood happen. You can remove this in about 30 minutes.
Ports are used to give all kinds of IV therapy, including chemotherapy, IV's, antibiotics, blood and blood products and also for drawing labs. This avoids the need to have other needle sticks.
Ports are flushed with heparin between uses. There are also a newer style of port that need only saline flushes and no heparin at all. They are also flushed monthly if they have not been used at all to prevent it from clotting. Be sure that you have a medical device card that tells you and your caregivers which kind of port you have. Ports may be left in for years. When not in use they require no care other than the monthly flushes as discussed. A simple surgery is needed to remove them when they are no longer needed.
"HICKMAN, BROVIAC, and GROSHONG"
These central line devices are also inserted surgically with a local anesthetic. They are usually placed in the upper chest although the femoral vein in the groin may also be used. With these catheters, there is no "port", and the catheter comes out from your body for about 12 inches. It has a special cap on the end where IV's are connected. Between uses, the cap is left in place to keep the catheter sealed from the air. Caps are usually changed at least every 3 days.
Most of these catheters are single or one line, but there are catheters which have double lumens and even triple lumens. Caregivers call lumens the number of parts to the catheter with separate caps that you have outside your body. Two or three different lumens allow caregivers to give you more than one IV medication or solution at a time.
Use of the "HICKMAN, BROVIAC, and GROSHONG"
These catheters are used most commonly for therapy for leukemia and for bone marrow or stem cell transplants. No needles need to be put into the patient at all to use these catheters. The IV’s are connected directly to the end of the catheter where the cap is. All of the same kinds of IV's that can be given in a port can also be given in one of these catheters. Lab specimens may also be drawn from these lines.
The exact type of the catheter will determine the flushing procedures and care of them. GROSHONG® catheters have a special design that does not require heparin flushes. GROSHONG® catheters need only normal saline (sterile salt-water) flushes weekly when not in use. HICKMAN® and BROVIAC® catheters need daily heparin flushes when not in use.
You will have a dressing placed over the site where these catheters enter the body. The size and kind of dressing varies depending upon the protocol of the institution. Changes of the dressing will also vary by institution and are anywhere from daily to weekly.
There are restrictions on swimming while these catheters are in place. Showers are generally allowed once the surgical site heals. They may also be left in place for long periods of time, and are removed relatively easily without surgery.
PICC's (Peripherally Inserted Central Catheters)
PICC’s are catheters which are inserted without surgery into one of the large veins in the antecubital area of the arm (where the arm bends). Nurses or physicians are specially trained in the insertion technique. These lines can be inserted in the home, physician’s offices or at the bedside in the hospital. It takes about 45 minutes to an hour to fully insert a PICC. The PICC is threaded into your large vein via an introducer needle. The needle is removed after the catheter is threaded through it. What you have left is about 6 to 10 inches of a flexible plastic catheter coming from the bend in your arm that has a dressing on it. On the end of the PICC is a cap much like with the GROSHONG® or HICKMAN®. This is where the IV's are attached or blood specimens are removed.
Use of the PICC
The PICC looks like the GROSHONG® or HICKMAN® catheter, but in a different location. PICCs are used for the same things as other central lines. PICCs are generally left in place for a few weeks or months at most. They are removed easily just by pulling them from the vein. There may be a stitch to help hold them in place on your skin, but usually a special dressing tape is used. Your caregivers will tell you about limiting any activity and use of your arm that the PICC is in so that it is not accidentally dislodged. Your PICC may require daily care with flushes and dressing changes. You must have a large vein in the antecubital area (bend of your arm) in order to have a PICC.
What are possible problems I could have from a central line?
Because these catheters are open into the body, there is a risk for infection. Their care requires meticulous technique. If the line becomes infected, it may need to be removed. Your physician or nurse will discuss this with you.
PICC catheters can cause irritation to the vein wall. This usually happens within the first 48 hours of insertion. Your arm above the catheter can become very red, tender and warm. This is called a local phlebitis. It usually resolves with heat and elevation of the arm.
These lines do, at times, clot off despite proper flushing. There are medications which may be used to dissolve the clot inside the catheter.
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