Central Venous Catheter: Types, Procedure & Daily Care Guide

What Is a Central Venous Catheter (CVC)?

A central venous catheter (CVC), also called a central line, is a thin flexible tube placed into a large vein that leads directly to or near the heart. It provides reliable vascular access for delivering medications, fluids, blood products, and nutrition, as well as drawing blood samples without repeated needle sticks.

Central venous catheters are essential medical devices used when patients need long-term intravenous access or when peripheral veins (in the arms or hands) are inadequate. The catheter tip typically rests in the superior vena cava, the large vein that carries blood from the upper body back to the heart, or at the junction where this vein meets the right atrium of the heart.

Unlike a standard IV line that goes into a small vein in your arm, a CVC accesses larger central veins that can handle concentrated medications, high-volume fluids, and solutions that would irritate smaller peripheral veins. This makes CVCs indispensable for chemotherapy, total parenteral nutrition (TPN), hemodialysis, and critical care situations where rapid medication delivery is essential.

The term "central" refers to the catheter's location in the central venous system, distinguishing it from peripheral IV catheters. Healthcare providers also use terms like "central line," "central venous access device," or specific names based on the catheter type (such as PICC line or Hickman catheter).

Why Would I Need a Central Venous Catheter?

Your healthcare team may recommend a CVC for several clinical situations. Understanding why you need this device can help you feel more prepared and engaged in your care.

Chemotherapy administration often requires a CVC because many chemotherapy drugs are vesicants, meaning they can cause severe tissue damage if they leak from a peripheral vein. The larger central veins dilute these medications quickly, reducing this risk. Additionally, chemotherapy regimens often last months, and repeated peripheral IV placements become impractical and uncomfortable.

Total parenteral nutrition (TPN) delivers complete nutrition directly into the bloodstream when the digestive system cannot be used. TPN solutions are highly concentrated and would damage smaller veins, making central access necessary. Patients recovering from major bowel surgery, those with severe inflammatory bowel disease, or individuals with other conditions preventing normal eating may need TPN through a CVC.

Long-term antibiotic therapy for serious infections like endocarditis (heart valve infection), osteomyelitis (bone infection), or complicated skin and soft tissue infections may require weeks of intravenous antibiotics. A CVC provides reliable access throughout the treatment course without the discomfort and complications of multiple peripheral IV placements.

Hemodialysis for kidney failure requires high blood flow rates that only large central veins can provide. Specialized dialysis catheters are designed for this purpose, though permanent dialysis access (arteriovenous fistula or graft) is preferred for long-term dialysis patients.

Critical care and emergency situations often necessitate central venous access for administering vasopressors (medications that raise blood pressure), monitoring central venous pressure, and ensuring reliable vascular access when peripheral veins are difficult to access due to shock, dehydration, or chronic illness.

What Are the Different Types of Central Venous Catheters?

The main types of central venous catheters include non-tunneled (short-term) CVCs lasting 1-4 weeks, PICC lines inserted through the arm lasting 1-6 months, tunneled catheters that can remain for months to years, and fully implanted ports that last 3-5 years or longer. Each type serves different clinical needs.

Healthcare providers select the catheter type based on how long you'll need it, what treatments you'll receive, your activity level, and other individual factors. Understanding the differences helps you participate in discussions about your care.

Non-Tunneled (Short-Term) Central Venous Catheters

Non-tunneled CVCs are the most common type used in hospitals, particularly in intensive care units and emergency departments. The catheter enters the skin directly over the target vein without any subcutaneous (under-the-skin) tunnel. These catheters are inserted into the internal jugular vein in the neck, the subclavian vein under the collarbone, or the femoral vein in the groin.

Short-term CVCs can be single-lumen (one channel) or multi-lumen (two, three, or four separate channels), allowing simultaneous administration of different medications. They are secured to the skin with sutures and covered with a sterile dressing. Because there is no protective tunnel, infection risk increases with duration, so these catheters are typically used for days to a few weeks rather than months.

The insertion procedure is relatively quick and can be performed at the bedside in the hospital. However, non-tunneled CVCs are more visible, require careful protection during bathing, and limit some activities.

Peripherally Inserted Central Catheters (PICC Lines)

A PICC line is inserted through a vein in the upper arm (typically the basilic, brachial, or cephalic vein) and threaded into the superior vena cava. Despite entering through a peripheral vein, the catheter tip ends in the central venous system, making it a central line.

PICC lines offer several advantages. They avoid the neck and chest area, reducing risks of pneumothorax (collapsed lung) and other insertion complications. They can remain in place for weeks to months, making them ideal for prolonged antibiotic courses, chemotherapy, and home infusion therapy. Patients often manage PICC line care at home with proper training.

However, PICC lines have limitations. They carry a higher risk of blood clots (thrombosis) in the arm vein compared to other central catheters. They also require arm immobilization during insertion and may limit certain activities. Specialized nurses or interventional radiologists typically place PICC lines, and ultrasound guidance is standard practice.

Tunneled Central Venous Catheters

Tunneled catheters, including Hickman, Broviac, and Groshong catheters, are designed for long-term use. The catheter travels through a subcutaneous tunnel before entering the vein, typically entering the skin on the chest wall and traveling under the skin to enter the internal jugular or subclavian vein.

The subcutaneous tunnel provides two key benefits. First, a Dacron cuff around the catheter within the tunnel stimulates tissue growth that anchors the catheter and creates a barrier against bacteria migrating along the catheter. Second, the tunnel separates the skin entry site from the vein entry site, reducing infection risk.

Tunneled catheters can remain in place for months to years with proper care. They are commonly used for patients receiving chemotherapy, long-term antibiotics, or parenteral nutrition at home. After the tissue grows around the cuff (about 2-4 weeks), sutures can be removed, and the catheter is more securely anchored.

Implanted Ports (Port-a-Cath, Mediport)

An implanted port consists of a small reservoir (port) connected to a catheter. The entire device is placed under the skin, usually on the chest below the collarbone. The port is accessed by inserting a special needle through the skin into the reservoir when treatment is needed.

Implanted ports offer significant lifestyle advantages. When not in use, the port requires only monthly flushing to maintain patency. Patients can swim, bathe, and participate in most activities without worrying about an external catheter. The port is barely visible under the skin and poses minimal infection risk when not accessed.

However, ports require a surgical procedure for placement and removal. Each access requires a needle stick through the skin, which may be uncomfortable for patients requiring frequent treatments. Ports are ideal for patients needing intermittent but long-term access, such as those receiving chemotherapy cycles over months or years.

How Should I Prepare for CVC Insertion?

Preparation for CVC insertion includes showering with antimicrobial soap, fasting for 4-6 hours if sedation is planned, informing your doctor about all medications (especially blood thinners), and wearing comfortable clothing. The specific requirements depend on whether you're getting a short-term or long-term catheter.

Proper preparation reduces infection risk and helps ensure a smooth procedure. Your healthcare team will provide specific instructions, but understanding the general requirements helps you prepare effectively.

Preparation for Short-Term CVC

For a standard non-tunneled CVC, preparation is relatively simple. Showering with regular soap and water and washing your hair with ordinary shampoo before the procedure is usually sufficient. You will change into hospital gowns at the facility.

Your healthcare provider will review your medications and may ask you to stop blood-thinning medications like warfarin, aspirin, or newer anticoagulants before the procedure. Never stop these medications without explicit instructions from your doctor, as stopping them inappropriately can cause other serious problems.

If the procedure will be done with sedation, you'll need to fast (no food or drink) for a specified period beforehand, typically 6-8 hours. Local anesthesia procedures may not require fasting, but confirm with your care team.

Preparation for Long-Term CVC (Tunneled Catheter or Port)

Long-term catheter placement typically involves more extensive preparation because infection prevention is even more critical for devices that will remain in place for months or years.

You may be instructed to shower the evening before and the morning of the procedure using chlorhexidine (CHG) or another antimicrobial soap. This special soap, available at pharmacies, helps reduce bacteria on your skin. Follow the package instructions carefully, paying particular attention to the chest, neck, and underarm areas.

Specific instructions for the evening before include:

• Shower and wash thoroughly with the prescribed antimicrobial soap
• Wash your hair with the antimicrobial solution
• Use a clean towel to dry off
• Put on clean clothes
• Sleep on clean sheets

On the morning of the procedure, repeat the shower with antimicrobial soap and wear fresh, clean clothes to the hospital. At the facility, you'll change into special patient attire.

Fasting Requirements

You will typically need to avoid eating, drinking, smoking, and using tobacco products before the procedure. The specific fasting duration varies by institution and whether sedation or anesthesia will be used. Your healthcare team will provide specific instructions about when to stop eating and drinking.

Medications Before the Procedure

At the facility, you may receive medications to help with the procedure:

• Pain medication: A mild analgesic tablet may reduce post-procedure discomfort
• Anxiolytic medication: If you're feeling anxious, a mild sedative can help you relax
• Antibiotics: While not routinely needed (infection risk is low with proper technique), some patients may receive prophylactic antibiotics

What Happens During CVC Insertion?

CVC insertion involves lying on a procedure table, cleaning and draping the insertion site, injecting local anesthetic, using ultrasound to visualize the vein, inserting the catheter through a needle and guidewire, securing it with sutures or a device, and confirming position with a chest X-ray. The procedure takes 30-60 minutes.

Understanding what will happen during the procedure can help reduce anxiety. The specific steps vary slightly depending on the catheter type and insertion location, but the general process follows a similar pattern.

Positioning and Monitoring

You will lie on your back on a procedure table or hospital bed. For jugular or subclavian vein insertion, you may be positioned with your head turned slightly away from the insertion side and possibly in a slight head-down (Trendelenburg) position. This position makes the veins larger and easier to access while reducing air embolism risk.

ECG (electrocardiogram) electrodes will be placed on your skin to monitor your heart rhythm throughout the procedure. A pulse oximeter clip on your finger tracks blood oxygen levels. These monitors help ensure your safety during the procedure.

Sterile Preparation

The healthcare provider will clean the insertion area with an antiseptic solution, typically chlorhexidine, which may feel cold on your skin. Sterile drapes will be placed around the area to create a sterile field. Everyone performing or assisting with the procedure will wear sterile gowns, gloves, masks, and caps.

Local Anesthesia

The insertion site is numbed with local anesthetic, usually lidocaine. You'll feel a brief stinging or burning sensation as the anesthetic is injected, similar to a dental injection. Within a minute or two, the area becomes numb. You may feel pressure during the rest of the procedure but should not feel sharp pain. Tell your healthcare provider immediately if you experience significant discomfort so additional anesthetic can be given.

Ultrasound-Guided Insertion

Modern CVC insertion uses real-time ultrasound guidance, which has dramatically improved safety. The ultrasound shows the vein and surrounding structures, allowing the provider to see exactly where the needle is going. This reduces complications by up to 71% compared to the older "landmark" technique that relied on external anatomical reference points.

The provider will place the ultrasound probe on your skin near the insertion site. You'll see (if you look at the screen) the vein as a dark, compressible structure. The needle appears as a bright white line as it enters the vein.

Catheter Placement

Using the Seldinger technique, the provider advances a needle into the vein, confirmed by blood return. A thin guidewire is threaded through the needle into the vein. The needle is removed, leaving only the guidewire in place. The catheter then advances over the guidewire into position, and the guidewire is removed.

For tunneled catheters, an additional step creates the subcutaneous tunnel. A small incision is made at the intended skin exit site (on the chest), and a tunneling device passes the catheter under the skin from the vein entry site to the exit site.

During catheter advancement, you may feel some pressure or hear a slight "clicking" sensation. If the catheter touches the heart wall, you might notice a brief irregular heartbeat—this is monitored on the ECG and is usually harmless.

Securing and Dressing

Once positioned correctly, the catheter is secured to your skin. Short-term catheters typically use sutures or specialized securement devices. Tunneled catheters have a Dacron cuff that eventually grows into the surrounding tissue, but sutures hold it in place initially.

A sterile transparent dressing covers the insertion site. This dressing allows visual inspection of the site while protecting against contamination. You may also have a small gauze pad under the dressing for the first 24 hours if there's any oozing.

Confirmation X-Ray

Before the catheter is used, a chest X-ray confirms proper tip position. For CVCs, the ideal tip location is at the junction of the superior vena cava and right atrium or within the lower third of the superior vena cava. This X-ray also checks for pneumothorax (collapsed lung), a potential complication of subclavian or internal jugular insertion.

Pediatric Considerations

Children typically receive sedation or general anesthesia for CVC insertion. A parent or caregiver can usually accompany the child into the procedure room and stay until the child falls asleep. The steps are otherwise similar, though smaller catheters and equipment are used.

What Happens After CVC Insertion?

After CVC insertion, you'll be monitored briefly, receive a chest X-ray to confirm position, and may experience mild discomfort for 1-2 days. Most patients return home the same day. You should not drive yourself home if you received sedation.

The immediate post-procedure period focuses on ensuring the catheter is properly positioned and functioning and that no complications have occurred.

Recovery Room

After the procedure, you may remain on the procedure table or be moved to a recovery area. Staff will check the insertion site, monitor your pulse, breathing, and blood pressure, and ensure you're comfortable. If you received sedation, you'll remain under observation until fully alert.

A chest X-ray is typically obtained before you leave the procedure area. The physician reviews this to confirm proper catheter tip position and rule out pneumothorax. Once the X-ray is reviewed, the catheter can be used for treatment.

Going Home

Most patients go home the same day after CVC placement. If you received sedation, you must have someone else drive you home. You should not drive, operate machinery, or make important decisions for 24 hours after sedation.

You can usually eat and drink normally after the procedure. Mild discomfort at the insertion site is common for the first day or two. Over-the-counter pain relievers like acetaminophen (paracetamol) or ibuprofen usually provide adequate relief. Your healthcare team will advise on specific pain management.

Activity Restrictions

Specific activity restrictions depend on the catheter type and your overall condition. General guidelines include:

• Avoid heavy lifting or strenuous upper body activity for the first few days
• Keep the dressing dry—cover it with plastic wrap during showers initially
• Avoid submerging the catheter site in water (no swimming or baths) until your healthcare team approves
• Be careful not to pull or snag the catheter on clothing or objects

How Do I Care for My CVC at Home?

Daily CVC care includes inspecting the insertion site for signs of infection, keeping the dressing clean and dry, changing dressings weekly or when soiled, flushing the catheter as directed, and protecting the catheter during activities. Report any signs of infection (fever, redness, swelling, drainage) immediately.

Proper catheter care at home is crucial for preventing complications, especially infection. Your healthcare team will provide training and written instructions specific to your catheter type. The following information offers a general overview.

Daily Inspection

Look at the insertion site every day. The transparent dressing allows you to see the site without removing the dressing. Use a mirror if the site is hard to see directly. Check for:

• Redness: Some redness immediately around the sutures is normal initially, but spreading redness is concerning
• Swelling: Mild swelling may occur initially but should improve, not worsen
• Drainage: A small amount of clear or blood-tinged drainage may occur in the first 24 hours, but pus or persistent drainage is abnormal
• Pain or tenderness: Mild discomfort is normal initially, but increasing pain suggests a problem
• Catheter position: Note if the catheter appears to have moved or if more of the catheter is outside your body than before

Dressing Changes

The sterile dressing covering your catheter insertion site needs regular changing, typically once a week or whenever it becomes loose, wet, or soiled. For short-term catheters in the hospital, nursing staff perform dressing changes. For home care, you may be trained to do this yourself, have a family member assist, or have a home health nurse visit.

Dressing change supplies include:

• Sterile gloves
• Chlorhexidine or other approved antiseptic
• Sterile transparent dressing
• Tape or securement device
• Alcohol swabs for the catheter hub

Strict sterile technique during dressing changes prevents introducing bacteria to the site. If you're performing dressing changes at home, ensure you've received proper training and feel confident in the technique.

Long-Term CVC Care

For tunneled catheters, once the Dacron cuff has healed into the tissue (typically 3-4 weeks), sutures can be removed. At this point, the catheter is more securely anchored by the tissue growth. You may no longer need a dressing over a tunneled catheter exit site once it's fully healed, though this varies by institution and catheter type. Always follow your specific care team's instructions.

Flushing the Catheter

Catheters that aren't in constant use need regular flushing to prevent blood from clotting inside and blocking the catheter. Flushing protocols vary:

• PICC lines and non-tunneled CVCs: Often flushed with saline every 8-12 hours or before and after each use
• Tunneled catheters: Flushed with saline and/or heparin (a blood thinner) per your care team's protocol
• Implanted ports: Flushed monthly when not in use

Your healthcare team will teach you or your caregiver the proper flushing technique if you'll be managing this at home. Always use the "push-pause" technique (pushing small amounts of flush solution rather than continuous pressure) and proper clamping sequence.

Bathing and Swimming

Protecting your catheter from water is important to prevent infection. General guidelines:

• Showers: Usually allowed with proper protection. Cover the dressing with plastic wrap or a waterproof cover. Position your body so direct water spray doesn't hit the site.
• Baths: Generally not recommended for external catheters, as submersion increases infection risk.
• Swimming: Usually not allowed with external catheters. Implanted ports may allow swimming when not accessed and fully healed—ask your care team.

What Are the Risks and Complications of CVCs?

CVC complications include infection (1-5 per 1,000 catheter-days), blood clots (2-26% of patients), pneumothorax during insertion (1-3% for subclavian approach), bleeding, catheter malposition, and air embolism. Most complications are preventable with proper insertion technique and ongoing care.

While CVCs are generally safe and often essential for treatment, understanding potential complications helps you recognize problems early and seek appropriate care.

Catheter-Related Bloodstream Infection (CRBSI)

Infection is the most common serious complication of central venous catheters. Bacteria can enter the bloodstream through the catheter, causing a serious infection called catheter-related bloodstream infection (CRBSI) or central line-associated bloodstream infection (CLABSI).

Infection rates vary based on catheter type, insertion site, duration, and care practices. With modern prevention bundles (standardized sets of evidence-based practices), rates have decreased significantly to approximately 1-5 infections per 1,000 catheter-days. Signs of catheter infection include:

• Fever or chills, especially occurring when the catheter is used
• Redness, warmth, swelling, or tenderness at the insertion site
• Pus or discharge from the insertion site
• General feeling of illness or fatigue

If infection is suspected, blood cultures are drawn from the catheter and from a peripheral vein. Treatment typically involves antibiotics and may require catheter removal, depending on the organism and severity.

Thrombosis (Blood Clots)

Blood clots can form in or around the catheter. Catheter-related thrombosis occurs in 2-26% of patients, though many clots cause no symptoms. Risk factors include larger catheter diameter, certain catheter tip positions, and underlying conditions that increase clotting risk.

Symptoms of catheter-related thrombosis may include:

• Swelling of the arm, neck, or face on the catheter side
• Pain or heaviness in the affected area
• Visible distension of veins on the chest or arm
• Catheter dysfunction (difficulty infusing or drawing blood)

Treatment usually involves anticoagulation (blood thinners). The catheter may or may not need removal, depending on whether it's still functional and needed for treatment.

Pneumothorax

Pneumothorax (collapsed lung) is a potential complication of subclavian and internal jugular CVC insertion. The needle can accidentally puncture the lung, allowing air to leak into the chest cavity and cause the lung to collapse partially or completely.

Pneumothorax rates have decreased dramatically with ultrasound guidance, occurring in approximately 1-3% of subclavian insertions (less with ultrasound). Symptoms include:

• Sudden shortness of breath
• Sharp chest pain, often on the side of catheter insertion
• Rapid breathing

The chest X-ray obtained after insertion checks for pneumothorax. Small pneumothoraces may resolve on their own with observation; larger ones may require a chest tube to re-expand the lung.

Other Complications

Bleeding and hematoma: Some bleeding during insertion is expected, but significant bleeding or expanding hematoma (blood collection under the skin) may require additional intervention.

Arterial puncture: Accidentally entering an artery instead of a vein is usually recognized immediately and managed by applying pressure. Ultrasound guidance has reduced this complication.

Air embolism: Air entering the bloodstream through the catheter is rare but potentially serious. Proper technique during insertion and catheter care prevents this complication.

Catheter malposition: The catheter tip may be in a suboptimal position, such as too deep into the heart or in a branch vein. The confirmation X-ray identifies malposition, which is corrected by repositioning or replacing the catheter.

How Is a CVC Removed?

Non-tunneled CVCs and PICC lines are removed at the bedside in a few minutes—you may feel slight pressure but no pain. Tunneled catheters require minor surgical removal. Implanted ports require outpatient surgery. After removal, pressure is applied to the site, and you'll be monitored briefly.

Catheter removal is typically straightforward, though the process varies by catheter type.

Removal of Non-Tunneled CVCs and PICC Lines

These catheters are removed at the bedside without anesthesia. The dressing is removed, sutures (if present) are cut, and the catheter is gently pulled out. You may feel slight pressure or a brief tugging sensation but should not feel pain.

After removal, firm pressure is applied to the site for several minutes to prevent bleeding. A sterile dressing is placed, and you'll be instructed to keep the site clean and dry and to report any bleeding, swelling, or signs of infection.

Removal of Tunneled Catheters

Because tunneled catheters have a Dacron cuff that has grown into the tissue, removal requires a minor surgical procedure. Local anesthetic is injected around the cuff location, a small incision is made to free the cuff from the tissue, and the catheter is pulled out.

The incision is typically closed with a suture or adhesive strips. Recovery is similar to the initial insertion—mild discomfort for a day or two, manageable with over-the-counter pain relievers.

Removal of Implanted Ports

Port removal is a minor surgical procedure, typically done as an outpatient under local anesthesia. An incision is made over the port, the port and attached catheter are removed, and the incision is closed. You'll have a small scar similar to the insertion scar.

Understanding Your Role in CVC Care

You have the right to understand your care, ask questions, and participate in decisions. Informed consent is required before insertion. Tell your healthcare team about allergies, previous catheter problems, and any concerns. Ask questions about anything you don't understand.

Being an active participant in your healthcare improves outcomes and satisfaction. Your healthcare team should provide clear information and answer your questions.

Informed Consent

Before CVC insertion, you (or your guardian if you're a minor or incapacitated) will be asked to provide informed consent. This process ensures you understand why the catheter is needed, what the procedure involves, potential risks and benefits, and alternatives. You have the right to ask questions and take time to consider before signing.

Questions to Ask

Consider asking your healthcare team:

• Why do I need a CVC? Are there alternatives?
• What type of catheter is recommended for me and why?
• How long will I need the catheter?
• What are the risks, and how can they be minimized?
• What symptoms should I watch for at home?
• Who should I contact if I have concerns?
• What activities should I avoid?
• Will I need home nursing visits for catheter care?

Communication Needs

If you don't speak the local language fluently or have hearing impairment, you're entitled to interpreter services or accommodations to ensure you fully understand your care. Children should be included in age-appropriate discussions about their treatment.