Central Line

“CVL” or “central line” for short, describes a catheter placed usually in a neck (internal jugular vein) or groin (femoral vein) vein, though it can also be placed in the liver (transhepatic), chest (subclavian), or back (translumbar) veins. They are placed to provide long-term intravenous access or when attempts to achieve peripheral intravenous access have failed.  CVLs can either be tunneled (buried under a portion of the skin) or non-tunneled. Non-tunneled CVLs are usually in place for less than two weeks whereas tunneled CVLs can be in place anywhere from two weeks to several months.

A central line can be placed for many reasons ranging from administration of antibiotics or chemotherapy to performing dialysis or pheresis, which are different ways to filter the blood. The hub of the catheter is on the external tip and is what connects to the dialysis or apheresis tubing or where nurses attach syringes to administer medicine and fluids or collect blood. Your family will receive significant education on the skin care surrounding the catheter site as well as on the proper usage and maintenance.

About this Treatment

About this Treatment

How do we perform a central venous line insertion?

First, after thoroughly cleaning the skin and covering it with drapes, a doctor will use an ultrasound machine to locate the appropriate vein under the skin. He or she will inject some local anesthesia around the insertion site and then insert a hollow needle into the vein. X-rays (fluoroscopy) will be used to help them guide a wire and then a catheter to the appropriate location next to the heart. The external portion of the catheter will be stitched to the skin and exposed (non-tunneled) or buried under a layer of skin and a much smaller portion remaining exposed (tunneled).

Will my child be awake during the procedure and is there any pain associated with?

We will use either IV sedation or general anesthesia so that your child isn’t awake. This will minimize any pain felt during the procedure but the insertion site may be tender for several days after.

Will my child be in any pain?

Your child will not feel pain during the procedure but some patients may feel discomfort around the catheter insertion site for a few days following the procedure.

How long does the procedure take?

The procedure will take approximately one hour.  Some children may need to arrive many hours before the procedure to have certain lab tests performed, which will be clearly communicated to you.

What risks are associated with this procedure?

The procedure is considered low-risk. However, potential complications, which will be explained again at the time of consent, include:

  • Bleeding
  • Tenderness or soreness at the site where the tube is placed
  • Infection
  • Puncture of adjacent structures, such as other veins or arteries
  • Air embolism (air in the veins)
  • Collapse of the lung (pneumothorax)
  • Bleeding into the chest (hemothorax)
  • Catheter breakage (upon removal)
  • Allergic reaction to the x-ray dye
Pre and Post Operative Care

Pre and Post Operative Care

How do my child and I prepare for the procedure?

We encourage good communication between you and your child, including the necessity and overview of the procedure as well as ensuring them that you are close by the whole time. Holding them or their hands until they leave for the procedure is a great way to provide support.

You will be given specific instructions along the way but you may need to arrive a few hours before the scheduled procedure to have some blood tests done. When you arrive at the hospital, a doctor will review the procedure and associated risks, after which you will sign a consent form. When we are ready to get started with the procedure, a nurse will place an intravenous line to deliver sedating medications and you will be allowed to accompany your child in the operating room until they are asleep, after which you will be escorted to a waiting room.

What happens after the procedure?

Nurses will monitor your child in the recovery area for a couple hours for successful recovery from any sedating medications, if any, and any immediate complications. The doctor may decide to have your child admitted to the hospital for an overnight stay. As mentioned, there may be some discomfort around the catheter insertion site for some days following the procedure, which is easily relieved by over-the-counter medications. It is important to keep the bandage surrounding the tube clean and dry.

When can I remove the bandages?

Do not remove the bandage and keep it clean and dry at all times. Please contact our department if the bandage is becoming loose or falls off. The bandage should be changed once a week and an appointment should be made to have this done unless a family member has been trained in changing the bandage.

When can my child resume normal activities like playing?

Your child will be able to resume a normal lifestyle within a couple days but certain activities that can result in pulling of the catheter, such as contact sports and rough playing, must be avoided.

When will my child be able to start bathing or swimming?

Your child should refrain from showering or bathing until the insertion site bandage is removed 48 hours after the procedure. After that, children with non-tunneled catheters should only sponge bathe and those with tunneled catheters may shower and bathe so long that water is not directly coming into contact with catheter and it does not become fully submerged under water.  Swimming is not allowed for either catheter.

How and when will the central line be removed?

Removing tunneled catheters is easier and faster than placing them and is often done without any sedation. First the stitches are cut from the skin and the catheter is pulled out from the body.  Pressure is applied to the insertion site during removal and for a few minutes after to minimize any bleeding that may occur. Non-tunneled catheters usually require IV sedation or general anesthesia as removal requires dissection (loosening of the skin around the buried portion of the catheter) with instruments before the catheter can be pulled out. We will place a bandage that you can remove in 48 hours. All lines remain in place for a time period determined by the managing physician but typically until the underlying disease has been treated properly by the intravenous medication.


•     Redness, pain, swelling, or bruising at the needle insertion site.

•     Fever higher than 101o Fahrenheit or 38o Celsius.

•     A change in color or temperature to the associated extremity.

•     Numbness, swelling, or pain of the associated extremity.

The department of Interventional Radiology can be reached at: 202-476-3791, Monday through Friday, between 8 a.m. and 5 p.m.

At all other times please call 202-259-8643, which is the on-call pager. Follow the instructions and wait for a call back.

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