Preparing for Medical Procedures: Catheters, IV Lines & What to Expect

What Are Vascular Access Devices and Why Are They Used?

Vascular access devices are medical tubes (catheters) placed in blood vessels to deliver medications, fluids, blood products, and nutrition directly into the bloodstream, or to draw blood samples for testing. They range from simple peripheral IVs lasting days to implanted ports lasting years, chosen based on treatment duration and type.

When you need medical treatment that must be delivered directly into your bloodstream, healthcare providers use vascular access devices. These specialized catheters create a pathway from outside your body into a vein, allowing for efficient delivery of medications, intravenous fluids, chemotherapy, antibiotics, blood transfusions, and parenteral nutrition. They also enable healthcare providers to draw blood samples without repeated needle sticks, which is particularly beneficial for patients requiring frequent blood tests.

The choice of vascular access device depends on several factors, including how long you will need treatment, what type of medications you will receive, the condition of your veins, and your overall health status. Some treatments, particularly certain chemotherapy drugs and concentrated nutrition formulas, can damage smaller peripheral veins and require placement in larger central veins where blood flow quickly dilutes the solution. Understanding the different options available can help you participate in discussions about your care and know what to expect.

Healthcare providers carefully assess each patient's individual needs before recommending a specific type of vascular access. This assessment includes reviewing your medical history, examining your veins, considering the planned treatment duration, and discussing your lifestyle and preferences. The goal is always to select the device that best meets your treatment needs while minimizing the risk of complications and impact on your daily life.

Common reasons for vascular access

Vascular access devices serve many important medical purposes. Patients undergoing chemotherapy often require central lines or ports because the medications can be harsh on smaller veins. Those receiving long-term antibiotic therapy for serious infections may need PICC lines that can remain in place for weeks. Patients who cannot eat or digest food normally may require central access for total parenteral nutrition (TPN), which delivers complete nutrition directly into the bloodstream.

Blood transfusions, dialysis, and administration of blood products also frequently require vascular access. Additionally, these devices are essential in emergency situations where rapid administration of fluids and medications can be lifesaving. In intensive care settings, central lines allow monitoring of blood pressure and heart function from inside the vessels themselves, providing crucial information for managing critically ill patients.

What Are the Different Types of Catheters and IV Lines?

The four main types of vascular access devices are: peripheral IV catheters (short-term, placed in hand or arm veins), peripherally inserted central catheters or PICC lines (medium-term, inserted in arm reaching to central vein), central venous catheters (placed in neck or chest veins for long-term use), and implanted ports (surgical placement under skin for years of use).

Understanding the different types of vascular access devices helps you prepare for the specific procedure you may need and know what to expect during your treatment. Each type has distinct characteristics, advantages, and appropriate uses. Healthcare providers select the most suitable device based on your treatment requirements, expected duration of therapy, and individual patient factors.

Peripheral IV Catheters

A peripheral intravenous (IV) catheter is the most common type of vascular access device. This short, flexible plastic tube is inserted into a small vein in your hand, forearm, or sometimes foot. Peripheral IVs are typically used for short-term treatments lasting hours to a few days, such as receiving fluids during a hospital stay, getting medications during surgery, or receiving antibiotics for an acute infection.

The insertion of a peripheral IV is relatively quick and can be performed by nurses at the bedside. You will feel a brief pinch or sting when the needle enters the skin, similar to having blood drawn. Once the catheter is in place and the needle removed, you should not feel pain from a properly functioning IV. According to current guidelines, peripheral IVs should be replaced every 72 to 96 hours to reduce infection risk, though they may need to be changed sooner if problems develop.

Peripheral IVs work well for many common medications and fluids but have limitations. They cannot be used for highly concentrated solutions, certain chemotherapy drugs, or medications that irritate smaller veins. If your treatment requires these substances or will last longer than a few days, your healthcare team will discuss other options with you.

Central Venous Catheters

Central venous catheters (CVCs), also called central lines, are longer catheters inserted into large veins in the neck (internal jugular vein), under the collarbone (subclavian vein), or in the groin (femoral vein). The tip of the catheter reaches the superior vena cava, the large vein just above the heart, where blood flow is high enough to quickly dilute medications. This makes central lines suitable for medications that would damage smaller veins.

Central line insertion is performed by physicians using sterile technique and often with ultrasound guidance for precise placement. You will receive local anesthesia to numb the area, so you will feel pressure but should not feel significant pain during the procedure. Some patients, particularly children or anxious adults, may receive sedation for added comfort. A chest X-ray is usually taken after insertion to confirm proper placement before the line is used.

There are several types of central venous catheters. Non-tunneled catheters are inserted directly through the skin and are used for shorter-term needs, typically days to weeks. Tunneled catheters travel under the skin for several inches before entering the vein, which helps reduce infection risk and allows them to remain in place for months or even years. Common tunneled catheter brands include Hickman, Broviac, and Groshong catheters.

PICC Lines (Peripherally Inserted Central Catheters)

A PICC line is a long, thin catheter inserted into a vein in your upper arm, usually above the elbow. Despite being inserted peripherally, the catheter is long enough to extend through the veins until its tip rests in the superior vena cava, making it technically a central line. PICC lines combine some advantages of both peripheral and central catheters: they can be inserted at the bedside without the risks associated with neck or chest insertion, yet they can remain in place for extended periods and deliver the same medications as other central lines.

PICC line insertion is typically performed by specially trained nurses or radiologists. The procedure uses ultrasound guidance to find a suitable vein and ensure proper placement. You will receive local anesthesia, and the insertion usually takes 30 to 60 minutes. Many patients find PICC line insertion more comfortable than central line placement because it avoids the neck and chest area.

PICC lines are excellent choices for treatment lasting several weeks to months, such as long-term antibiotic therapy, chemotherapy, or parenteral nutrition at home. They require regular care including flushing and dressing changes, which can often be performed by the patient or a caregiver after proper training. However, PICC lines in the arm may limit some activities and can occasionally cause arm swelling or discomfort.

Implanted Ports (Subcutaneous Venous Ports)

An implanted port, also called a subcutaneous venous port or portacath, is a small device surgically placed completely under the skin, usually on the upper chest below the collarbone. The port consists of a small reservoir or chamber with a self-sealing rubber top connected to a catheter that extends into a large vein. When access is needed, healthcare providers insert a special needle through the skin into the port's rubber septum.

Port placement is a minor surgical procedure performed under local anesthesia with sedation, typically as an outpatient procedure. You will have a small incision where the port is placed and another where the catheter enters the vein. The wounds heal within one to two weeks, leaving small scars. Once healed, the port is completely hidden under the skin, appearing as a small bump that is usually barely noticeable.

Ports are ideal for patients who need intermittent long-term vascular access, such as those receiving chemotherapy cycles over months or years. Between uses, the port requires only monthly flushing to prevent clotting. The biggest advantage of ports is the freedom they offer: once healed, patients can swim, bathe, and engage in most normal activities without the external tubes and dressings required by other central lines. Ports can last three to five years or longer with proper care.

How Can I Reduce Pain During Catheter Insertion?

Pain during catheter insertion can be significantly reduced using topical anesthetic cream (like EMLA or lidocaine cream) applied 30-60 minutes before the procedure. For central lines and ports, local anesthetic injections numb the area. Children and anxious adults may receive sedation. Distraction techniques, slow breathing, and staying relaxed also help minimize discomfort.

Fear of pain is one of the most common concerns patients have about medical procedures involving needles and catheters. The good news is that modern medicine offers several effective options for minimizing discomfort. By understanding and utilizing these options, you can significantly reduce the pain associated with vascular access procedures.

Topical anesthetic creams, such as EMLA (a mixture of lidocaine and prilocaine) or other lidocaine-based products, work by numbing the skin where they are applied. These creams are particularly effective for peripheral IV insertions and blood draws. For best results, the cream should be applied in a thick layer to the intended insertion site and covered with an occlusive dressing (usually provided with the cream or using plastic wrap) for 30 to 60 minutes before the procedure. Maximum numbing effect occurs at 60 minutes.

When the dressing is removed and the cream wiped away, the skin may appear pale or slightly reddened, which is normal. The numbing effect lasts one to two hours after removal, providing ample time for the procedure. Studies consistently show that topical anesthetics significantly reduce pain scores during venipuncture and IV insertion, making them especially valuable for children and patients with needle anxiety.

Using topical anesthetic cream effectively

To get the most benefit from topical anesthetic cream, proper application is important. First, identify where the needle will likely be inserted – common sites include the back of the hand, the inner elbow area, or the top of the foot. If you are unsure, apply cream to two or three potential sites. Clean and dry the skin before application.

Squeeze out a thick blob of cream, approximately the size of a coin, and apply it to each site without rubbing it in. Cover each application with the provided occlusive dressing, sealing the edges to prevent the cream from drying out. Note the time of application so you know when 30-60 minutes have passed. If you are going to a medical facility, you can apply the cream at home before leaving, accounting for travel time.

Some important precautions: do not apply topical anesthetics to broken or irritated skin, and be aware of any allergies to local anesthetics. While these creams are available over-the-counter in many places, discuss their use with your healthcare provider, especially for children or if you have sensitive skin. Healthcare providers can also apply these creams upon arrival if you did not have time to apply them at home, though this may delay your procedure by 30-60 minutes.

Other pain management strategies

Beyond topical anesthetics, several other approaches can help manage procedural pain and anxiety. For central line and port insertions, local anesthetic is injected into the skin and deeper tissues, completely numbing the area. While you will feel pressure and movement, you should not feel sharp pain. If you do feel pain during a procedure, always tell your healthcare provider immediately so they can provide additional numbing.

Distraction techniques can be remarkably effective, especially for children. Watching videos, listening to music, playing games on a phone or tablet, or having a conversation during the procedure can redirect attention away from any discomfort. Taking slow, deep breaths helps relax muscles and reduces the perception of pain. Some facilities offer virtual reality headsets or other advanced distraction tools for procedures.

For patients with significant anxiety or for more complex procedures, sedation may be offered. This can range from mild anxiolytic medications that help you relax while remaining awake to deeper sedation where you may not remember the procedure. Discuss your anxiety level honestly with your healthcare team so they can provide appropriate support.

How Should I Prepare for a Medical Procedure?

Preparation for medical procedures typically includes following fasting instructions if required, wearing comfortable loose clothing with easy arm access, bringing a list of medications and allergies, arriving early, and arranging transportation home if receiving sedation. Tell your healthcare team about any previous difficult IV placements, bleeding disorders, or latex allergies.

Proper preparation for a medical procedure helps ensure everything goes smoothly and reduces anxiety on the day of your appointment. The specific preparation requirements vary depending on the type of procedure you are having, but some general principles apply to most situations involving vascular access devices.

If you are having a procedure that requires sedation, you will typically need to fast (not eat or drink) for a specified period beforehand, usually 6-8 hours for solid foods and 2 hours for clear liquids. Your healthcare team will provide specific instructions. Fasting reduces the risk of complications if sedation is used. However, for simple peripheral IV placement or PICC line insertion without sedation, fasting is usually not required.

On the day of your procedure, wear comfortable, loose-fitting clothing. For arm procedures, wear short sleeves or clothing that can easily be rolled up or removed. Avoid applying lotions or creams to the arm or area where the catheter will be placed, as this can make the skin slippery and difficult to clean properly. If you plan to use topical anesthetic cream, bring it with you or apply it at home with appropriate timing.

What to bring and what to tell your healthcare team

Bring a current list of all medications you take, including prescription medications, over-the-counter drugs, vitamins, and supplements. This is important because some medications, particularly blood thinners, may need to be adjusted before certain procedures. Also bring a list of any drug allergies or previous adverse reactions to medications or medical products.

It is particularly important to inform your healthcare team if you have any of the following: previous difficult IV placements or multiple attempts needed in the past, a history of blood clots, a bleeding disorder or taking blood-thinning medications, an allergy to latex or adhesive tape, a pacemaker or implanted defibrillator, previous radiation therapy to the chest area, or lymph node removal on either side (which may affect where catheters can be placed).

If you have had a mastectomy or lymph node removal, vascular access should generally be avoided on that side of the body. Similarly, patients on dialysis should protect their fistula arm. Do not hesitate to remind healthcare providers about these factors, even if it is documented in your medical record, as an extra reminder can prevent problems.

Arranging transportation and support

If you will be receiving sedation for your procedure, arrange for someone to drive you home afterward. Sedation effects can last several hours, making it unsafe to drive, operate machinery, or make important decisions. Even for procedures without sedation, having someone accompany you can provide emotional support and help you remember post-procedure instructions.

Plan to arrive at your appointment early, typically 15-30 minutes before your scheduled time. This allows time for check-in, paperwork, and any last-minute preparations. Arriving rushed and stressed can make the procedure more difficult and increase anxiety.

What Should I Expect During the Procedure?

During catheter insertion, expect positioning on a bed or chair, skin cleaning with antiseptic, possible numbing with cream or injection, a brief pinch or pressure during insertion, securing with tape or sutures, and a bandage over the site. Central lines may include ultrasound guidance and a chest X-ray afterward to confirm placement.

Knowing what to expect during your procedure can significantly reduce anxiety. While the specific experience varies depending on the type of vascular access device being placed, understanding the general process helps you feel more prepared and in control.

Peripheral IV insertion

For peripheral IV placement, you will typically be seated in a chair or lying on a bed with your arm resting comfortably. The healthcare provider will examine your veins to select the best site, usually on the back of your hand or forearm. Some facilities use vein-finding devices that shine light through the skin to help locate suitable veins.

The selected area will be cleaned with an antiseptic solution, usually chlorhexidine or alcohol, and allowed to dry. If topical anesthetic was applied, the cream will be wiped away at this point. A tourniquet may be applied above the site to make the veins more visible and easier to access. You may be asked to make a fist to further distend the vein.

The actual insertion involves inserting a needle with the catheter over it into the vein. You will feel a pinch or sting that typically lasts only a second or two. Once blood return confirms the needle is in the vein, the catheter is advanced and the needle withdrawn, leaving only the soft plastic tube in the vein. The catheter is then secured with tape or a transparent dressing, and the IV is connected to tubing or capped for later use. The entire process usually takes just a few minutes.

PICC line and central line insertion

PICC line and central line insertions are more involved procedures that follow strict sterile technique to prevent infection. You will lie on a procedure table with the appropriate area exposed. For PICC lines, your arm will be positioned outward and the insertion site (usually upper arm) will be cleaned extensively with antiseptic. For central lines, your neck, chest, or groin area will be prepared similarly.

The healthcare provider will wear sterile gowns and gloves, and the area around the insertion site will be covered with sterile drapes, leaving only the insertion site visible. You will receive local anesthetic injected into the skin and surrounding tissue. This injection may sting briefly, but it will numb the area so you should not feel pain during the catheter insertion itself.

Using ultrasound guidance, the provider will locate the target vein and insert the catheter. You may feel pressure, pushing, or movement, but should not feel sharp pain. For PICC lines, you might feel an unusual sensation as the catheter advances through your arm toward your chest. Tell your provider if you experience pain, and they can provide additional numbing medication.

Once the catheter is in place, it will be secured with sutures or a special securement device and covered with a sterile dressing. For central lines in the neck or chest, a chest X-ray is usually taken to confirm proper placement before the line is used. The entire procedure typically takes 30-60 minutes.

Port implantation

Port implantation is a minor surgical procedure usually performed in an operating room or procedure suite. You will receive sedation in addition to local anesthesia, so you will be drowsy and may not remember much of the procedure. The surgeon will make a small incision on your upper chest where the port will be placed, and another small incision where the catheter will enter the vein.

The port is placed in a pocket created just under the skin, and the catheter is tunneled under the skin to the vein. An X-ray or fluoroscopy confirms proper placement. The incisions are closed with sutures or surgical glue. The procedure typically takes 30-60 minutes, followed by a recovery period while sedation wears off.

How Do I Care for My Catheter After the Procedure?

Catheter care includes keeping the site clean and dry, changing dressings as instructed (typically every 5-7 days or when soiled), flushing the line regularly to prevent clotting, watching for signs of infection (redness, swelling, pain, fever), and protecting the site during bathing. Never let anyone draw blood from or inject into your line without proper technique.

Proper care of your vascular access device is essential for preventing complications and ensuring it functions well throughout your treatment. The specific care requirements depend on the type of device you have, but some principles apply to most situations. Your healthcare team will provide detailed instructions tailored to your specific device and situation.

Keeping the site clean and dry

One of the most important aspects of catheter care is maintaining a clean, dry insertion site. The dressing covering your catheter serves as a barrier against bacteria, so it must remain intact and dry. If your dressing becomes wet, soiled, loose, or visibly dirty, it should be changed as soon as possible. For most catheters, routine dressing changes are recommended every 5-7 days, but your healthcare team may specify a different schedule.

When showering, you must keep the catheter site and dressing dry. Waterproof covers designed for this purpose are available at medical supply stores, or you can cover the site with plastic wrap secured with tape. Direct the water away from the catheter site and avoid prolonged exposure to steam. After showering, check that the dressing is still dry and intact.

Swimming and soaking in bathtubs, hot tubs, or pools is generally not recommended for patients with external catheters, as these environments increase infection risk even with waterproof covers. Implanted ports, once fully healed (usually 2-4 weeks after placement), offer more flexibility since they are completely under the skin and accessed only when needed.

Flushing and maintenance

Catheters must be flushed regularly to prevent blood clots from forming inside them. The flushing schedule and technique depend on your specific device. Peripheral IVs are typically flushed before and after each use. PICC lines and central venous catheters usually require daily flushing with saline solution, and some also need weekly flushing with a heparin solution to prevent clotting.

If you will be caring for your own catheter at home, your healthcare team will teach you the proper flushing technique, which involves using pre-filled syringes and a specific sequence of steps to ensure the line remains clear and uncontaminated. This training typically includes practice sessions before you leave the healthcare facility. Many patients and family members successfully learn these skills and perform them at home with confidence.

Implanted ports require flushing about once a month when not in regular use. This is usually done by a healthcare provider during a brief office visit. If you are receiving treatment through your port regularly (such as monthly chemotherapy), the port is flushed as part of each treatment session.

What Are the Warning Signs of Complications?

Warning signs requiring immediate medical attention include: redness, swelling, warmth, or tenderness at the catheter site; drainage or pus from the site; fever or chills; difficulty flushing the catheter; pain during infusion; swelling in the arm, neck, or face; shortness of breath; and any sudden change from normal. Contact your healthcare team immediately if you notice any of these signs.

While vascular access devices are generally safe when properly cared for, complications can occasionally occur. Recognizing the warning signs early and seeking prompt medical attention can prevent minor problems from becoming serious. It is important to know what is normal for your catheter and to trust your instincts if something seems wrong.

Signs of infection

Catheter-related infections are one of the most important complications to recognize early. Signs of a local infection at the insertion site include redness spreading from the catheter site, increasing swelling or puffiness around the site, warmth when you touch the area, tenderness or pain that was not present before, and any drainage or pus coming from the site.

Signs of a more serious bloodstream infection include fever (temperature over 38°C or 100.4°F), chills or shaking, rapid heartbeat, feeling generally unwell, confusion (especially in older adults), and low blood pressure. Bloodstream infections can become serious quickly, so if you develop fever or chills with a catheter in place, contact your healthcare provider immediately or go to an emergency department.

Other complications to watch for

Catheter occlusion (blockage) is another common issue. Signs include difficulty or inability to flush the catheter, the infusion pump alarming frequently, slow drip rate when infusing fluids, and inability to draw blood from the line. Sometimes gentle flushing can clear a minor blockage, but do not use excessive force, as this could damage the catheter or dislodge a clot. Contact your healthcare provider if you cannot easily flush your catheter.

Blood clots can form in the vein around the catheter (thrombosis). Warning signs include swelling in the arm on the side of a PICC line, swelling in the neck or face with central lines, pain or tenderness along the course of the catheter, and visible distension of veins on the chest or arm. These symptoms require prompt medical evaluation.

Other signs that require attention include catheter dislodgement or movement (if the catheter seems longer outside your body than before or has visibly moved), air in the line (air bubbles in the tubing), leakage of fluid around the catheter site, and any sudden sharp chest pain or difficulty breathing, which could indicate a rare but serious complication requiring emergency care.

When and How Is the Catheter Removed?

Catheters are removed when treatment is complete, when they develop problems, or when they reach their recommended lifespan. Peripheral IV removal is quick and painless. Central line and PICC line removal is usually simple, taking just a few minutes. Port removal requires a minor surgical procedure under local anesthesia. Most patients feel immediate relief when their catheter is removed.

Your vascular access device will be removed when you no longer need it. The timing depends on the completion of your treatment, any complications that may develop, and the type of device. Understanding the removal process can help you know what to expect when that time comes.

Peripheral IV and PICC line removal

Removing a peripheral IV is quick and simple. The tape or dressing is removed, and the catheter is gently pulled out of the vein. This takes only a second and usually causes minimal discomfort – most patients describe feeling a brief sliding sensation. Pressure is applied to the site for a few minutes to stop any bleeding, and then a small bandage is placed over the site. The tiny hole heals within a day or two.

PICC line removal is similarly straightforward. After removing the dressing, the healthcare provider gently pulls the catheter out through the insertion site. You may feel an unusual tugging or pulling sensation as the long catheter exits your arm, but it should not be painful. The provider will check that the entire catheter has been removed and apply pressure to the site until bleeding stops. A bandage is applied, and you may be asked to keep the arm elevated briefly.

Central line and port removal

Removing non-tunneled central venous catheters is similar to PICC line removal – the catheter is simply pulled out and pressure applied. Tunneled catheters require a small incision to free the cuff that holds them in place under the skin, but this is still typically a bedside procedure done with local anesthesia.

Port removal is a minor surgical procedure, as the device must be removed from under the skin. This is usually performed as an outpatient procedure under local anesthesia with or without sedation. The surgeon makes an incision over the port, frees it from surrounding tissue, removes the device, and closes the incision. Recovery is usually quick, similar to the original placement.

Many patients report feeling a sense of relief and milestone achievement when their catheter is removed, as it often marks the end of a treatment phase. The insertion sites heal well in most cases, leaving only small scars that fade over time.