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Central LineEdit

A central line, medically referred to as a central venous catheter, is a catheter placed into a large vein to provide reliable access to the venous system for a variety of therapeutic and monitoring needs. Unlike peripheral IV lines that access veins in the arms or hands, a central line is positioned so the catheter tip rests in a central vein, typically near the lower superior vena cava or the right atrium. This configuration allows faster delivery of medications that irritate smaller peripheral veins, rapid fluid administration, total parenteral nutrition, and the ability to draw blood repeatedly without repeated needle sticks. For broader terminology, see Central Venous Catheter.

Central lines come in several forms and are used in settings ranging from operating rooms to intensive care units, oncology wards, and nephrology clinics. Alongside them, devices such as Peripherally Inserted Central Catheters and implanted venous access devices (often called Port-a-Cath) provide alternatives with different duration-of-use profiles and complication risks. The central line family is central to modern intravenous therapy and critical care, but it also carries meaningful risks that require careful consideration and management.

Central line

Types and access sites

  • Central venous catheters can be classified by how they reach the central circulation and how long they are intended to stay. Non-tunneled lines are typically placed for shorter-term use, while Tunneled central venous catheters (such as Hickman- or Broviac-type devices) and implanted ports are designed for longer-term access. See Non-tunneled central venous catheter and Tunneled catheter for more detail.
  • Common access sites include the Internal jugular vein, the Subclavian vein, and the Femoral vein. Each site carries its own risk profile; for example, subclavian access has historically offered lower infection rates in some contexts but a higher risk of long-term venous stenosis, while internal jugular access is often favored for ease of ultrasound guidance and monitoring. See Internal jugular vein and Subclavian vein for background.
  • Peripheral access that reaches the central circulation is provided by the Peripherally Inserted Central Catheter, inserted through a peripheral vein and advanced to a central location. Implants like Port-a-Cath lie under the skin and provide long-term access with reduced daily handling.

Indications

  • Central lines are used when venous access needs to be reliable for extended periods, when medications are too irritant for small veins, or when rapid, large-volume administration is required. They are commonly used for Total parenteral nutrition, chemotherapy, vasopressor infusions, and rapid fluid resuscitation. They also enable repeated blood sampling and continuous hemodynamic monitoring in suitable patients. See Total parenteral nutrition and Chemotherapy for related discussions.

Risks and complications

  • The insertion and presence of a central line carry risks that must be balanced against the benefits. Common concerns include infection, bleeding, and mechanical complications. A leading concern is the risk of a bloodstream infection associated with central lines, often discussed under the term Central line-associated bloodstream infection. Other mechanical risks include pneumothorax or arterial puncture during access, catheter malposition, and thrombosis. See Pneumothorax, Blood clots, and Catheter-related infection for broader context.
  • Preventive strategies have evolved significantly. Use of sterile technique, antisepsis with chlorhexidine, full barrier precautions during insertion, and real-time imaging guidance have reduced complication rates in many settings. Some centers employ antimicrobial- or antiseptic-impregnated materials and antibiotic lock therapies to lower infection risk. See Ultrasound-guided cannulation and Antimicrobial-impregnated catheter for related topics.

Care, maintenance, and removal

  • Proper maintenance includes routine assessment of the line’s need, meticulous site care, and standardized flushing protocols to maintain patency. Decisions about duration of use are guided by clinical need, with emphasis on removing the line as soon as it is no longer necessary to minimize infection risk. See Sterile technique and Catheter care for relevant principles.
  • In some cases, specialized strategies such as antibiotic-lock therapy or routine site dressing changes may be discussed in clinical guidelines and institutional protocols. See Antibiotic lock therapy for more information.

Controversies and debates

  • Site selection remains a topic of professional discussion. Subclavian access can be associated with lower infection rates in some studies but carries concerns about long-term venous stenosis; internal jugular access is often preferred when there is a need to preserve other venous sites or to facilitate ultrasound guidance. The choice of site can depend on patient anatomy, risk factors, and the clinician’s expertise. See Subclavian vein and Internal jugular vein.
  • The balance between aggressive infection prevention and practical care has spurred debates about routine use of antimicrobial catheters, antibiotic locks, and the appropriate duration of line use. Some guidelines emphasize minimizing exposure by removing lines promptly, while others evaluate special measures that may reduce infection in high-risk populations. See Central line-associated bloodstream infection and Antimicrobial-impregnated catheter.
  • Technological advances—such as ultrasound guidance for insertion and real-time imaging to confirm placement—have reshaped practice and prompted ongoing evaluation of the best approaches in different clinical environments. See Ultrasound-guided cannulation.

See also