External Central Lines
What Are Central Lines?
A central line (also called a central venous catheter) is a type of intravenous (IV) line. A central line is much longer than a regular IV. It goes all the way up to a vein near the heart or just inside the heart.
Commonly used central lines include:
- external central lines (also called tunneled central lines)
- implantable ports
- PICC (peripherally inserted central catheter) lines
A central line can be used to give a child medicine, fluids, blood, or nutrition. It also can be used to draw blood.
What Are External Central Lines?
External central lines (tunneled central lines) go in through the skin near the collarbone:
- The line is tunneled under the skin and into a vein.
- Then, it's threaded through the vein.
- It ends in a large vein near the heart or just inside the heart.
The other end of the line stays outside the body, usually on the chest. It may divide into more than one line. Each line is covered with a cap. Health care providers attach syringes (a tube with a plunger) to the caps when they give medicine or draw blood. No needles are used, so there's no pain.
The two main types of external lines are Broviacs or Hickmans.
When Are Central Lines Used Instead of Regular IV Lines?
Central lines are thicker and more durable than a regular IV. They're also much longer and go farther into the vein. Doctors use a central line instead of a regular IV line because:
- It can stay in place for a longer time (up to a year or even longer).
- It lowers the number of needle sticks a child needs for blood draws.
- Patients can get large amounts of fluids or medicines (like chemotherapy) that might not go through regular IVs.
Doctors may place a central line for someone who:
- has a serious infection so they can get IV antibiotics for a few weeks
- has cancer so they can get chemotherapy and blood tests through the line
- needs IV nutrition
- needs many blood transfusions
How Is an External Central Line Placed?
Doctors place external central lines in an operating room, intensive care unit, or interventional radiology suite. The patient can be sedated (given medicine to relax) or receive general anesthesia (given medicine to go to sleep) so they won't feel pain when the central line is placed.
To place the external central line, a doctor will:
- Clean the skin where the line goes in.
- Put the central line into a vein in the chest using ultrasound to guide where the line goes.
- Thread the line into a large vein near the heart or just into the heart.
- Check the placement of the line with an X-ray.
- Place a dressing (a type of bandage) over the central line where it comes out of the skin.
Are There Risks to a Central Line?
There are some risks to a central line, but most don't cause problems. If problems do happen, it is usually because the line gets infected or stops working. Very rarely, a central line can cause a blood clot. Your doctor will review the risks with you before placing the central line.
When Should I Call the Doctor?
Check the central line area every day and call the doctor right away if:
- There are signs of an infection, such as:
- a fever
- redness or swelling near where the line is
- pain or tenderness where the line is
- The line comes out or gets blocked.
How Can Parents Help?
At home, a child's external central line needs special care to prevent infection and keep it working well. It's normal to feel a little bit nervous caring for the central line at first, but soon you'll feel more comfortable. You'll get supplies to use at home, and a visiting nurse may come to help you when you first get home. Ask your health care team:
- how often to change the dressing
- when and how to flush the line
- what to do if the line gets blocked or comes out
- how to give medicines through the central line (if you will be giving medicines at home)
- if the line has caps, how often to change them
- which physical activities are OK for your child (most kids with a central line need to avoid rough play and contact sports)
- how to protect the central line while your child bathes
- what signs of infection to watch for
Tell your child's teachers, school nurse, counselor, and physical education teacher about the central line. They can:
- Make sure your child avoids any activities that may damage the central line.
- Offer your child support during treatment.