A central line is a long, thin tube (catheter) that can be used to collect blood for testing or to give medicine through a vein. The tip of the central line ends in a large vein just above the heart (vena cava).

A central line may be placed because:

Your child needs to get medicines or fluids through an IV for a long period of time.
Your child needs nutrition but cannot eat or absorb nutrients.
The veins in your child’s hands or arms are hard to access.
Your child needs a blood transfusion.
Your child needs chemotherapy or dialysis.

Types of central lines

Four main types of central lines are used in children. They include:

Peripherally inserted central catheter (PICC) line. This type is used for access of one week or longer. A PICC looks like an IV tube, but it goes up the arm to the heart. It is usually inserted in the upper arm and taped in place on the arm.
Tunneled central line. This type is used for long-term therapy and dialysis. It is placed in a large vein in the neck, chest, or groin. A tunneled central line is inserted through a small incision made over the vein, and then it is advanced into the heart. It is tunneled under the skin and brought out through a second incision.
Non-tunneled central line. This type is used for short-term access, usually for a maximum of 7 days. It is often used in the emergency department or in acute care settings like an intensive care unit. A non-tunneled central line is inserted in the neck, chest, or groin.
Implanted port. This type is used for long-term therapy. It can stay in place longer than other types of central lines. An implanted port is normally inserted in the upper chest, but it can also be placed in the upper arm or in the abdomen. It is inserted and removed with surgery, and it is accessed using a needle.

The type of central line that your child receives depends on how long your child will need it, the child’s medical condition, and the condition of the child’s veins.

Tell a health care provider about:

Any allergies your child has.
All medicines your child is taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
Any problems your child or family members have had with anesthetic medicines.
Any blood disorders your child has.
Any surgeries your child has had.
Any medical conditions your child has.
Whether your child is pregnant or may be pregnant.

What are the risks?

Generally, placement and use of a central line is safe. However, problems may occur, including:

Infection.
A blood clot that blocks the central line or forms in the vein and travels to the heart.
Bleeding from the place where the central line was put in.
Developing a hole or crack within the central line. If this happens, the central line will need to be replaced.
Central line failure.
The catheter moving or coming out of place.

What happens before the procedure?

Ask your child’s health care provider about:
- Changing or stopping your child’s regular medicines. This is especially important if your child is taking diabetes medicines or blood thinners.
- Taking medicines such as aspirin and ibuprofen. These medicines can thin your child’s blood. Do not give these medicines to your child unless the health care provider tells you to give them.
- Taking over-the-counter medicines, vitamins, herbs, and supplements.
Follow instructions from your child’s health care provider about eating or drinking restrictions.
Ask the health care provider:
- How your child’s procedure site will be marked.
- What steps will be taken to help prevent infection. These steps may include:
  - Removing hair at the procedure site.
  - Washing skin with a germ-killing soap.

What happens during the procedure?

The procedure will vary depending on the type of central line being placed. In general:

An IV will be inserted into one of your child’s veins.
Your child will be given one or more of the following:
- A medicine to help him or her relax (sedative).
- A medicine to numb the area (local anesthetic).
Your child’s skin will be cleaned with a germ-killing (antiseptic) solution, and he or she may be covered with sterile drapes.
Your child’s heart rate, blood pressure, breathing rate, and blood oxygen levels will be monitored during the procedure.
The central line catheter will be inserted into the vein and advanced to the correct spot. The health care provider may use X-ray equipment to help guide the catheter to the right place.
A bandage (dressing) will be placed over the insertion area.

The procedure may vary among health care providers and hospitals.

What can I expect after the procedure?

Your child’s blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until he or she leaves the hospital or clinic.
Antiseptic caps may be placed on the ends of your child’s central line tubing.
If your child was given a sedative during the procedure, he or she can be affected for several hours. Do not let an older child drive or operate machinery until the health care provider says that it is safe.

Follow these instructions at home:

Flushing and cleaning the central line

Follow instructions from your child’s health care provider about flushing and cleaning the central line and the area around it.
Only use sterile supplies to flush the central line. The supplies should be from your child’s health care provider, a pharmacy, or another source that is recommended by the health care provider.
Before you flush the central line or clean the central line or the area around it:
- Wash your hands with soap and water for at least 20 seconds. If soap and water are not available, use hand sanitizer.
- Clean the central line hub with rubbing alcohol. Unless directed otherwise by the manufacturer’s instructions, scrub using a twisting motion and rub for 10 to 15 seconds or for 30 twists. Be sure you scrub the top of the hub, not just the sides. Never reuse alcohol pads. Let the hub dry before use. Prevent it from touching anything while drying.

Caring for the incision or central line site

Check your child’s incision or central line site every day for signs of infection. Check for:
- Redness, swelling, or pain.
- Fluid or blood.
- Warmth.
- Pus or a bad smell.
Keep the insertion site of your child’s central line clean and dry at all times.
Change the dressing only as told by your child’s health care provider.
Keep your child’s dressing dry. If it gets wet, have it changed as soon as possible.

General instructions

Follow instructions from the health care provider for the type of device that your child has.
Keep the tube clamped, unless it is being used.
If the central line accidentally gets pulled on, make sure:
- The dressing is okay.
- There is no bleeding.
- The line has not been pulled out.
Do not use scissors or sharp objects near the tube.
Do not let your child take baths, swim, or use a hot tub. Ask your child’s health care provider if he or she may take showers.
Let your child return to normal activities as told by your child’s health care provider. Your child may be restricted from lifting or making repetitive arm movements on the side where the central line is located.
Give over-the-counter and prescription medicines only as told by your child’s health care provider.
Keep all follow-up visits. This is important.

Storage and disposal of supplies

Keep your supplies in a clean, dry location.
Throw away any used syringes in a disposal container that is meant for sharp items (sharps container). You can buy a sharps container from a pharmacy, or you can make one by using an empty hard plastic bottle with a cover.
Place any used dressings or infusion bags into a plastic bag. Throw that bag in the trash.

Contact a health care provider if:

There is redness, swelling, or pain around your child’s insertion site.
There is fluid or blood coming from your child’s insertion site.
Your child’s insertion site feels warm to the touch.
There is pus or a bad smell coming from your child’s insertion site.

Get help right away if:

Your child has:
- A fever or chills.
- Shortness of breath.
- Chest pain or a racing heartbeat.
- Swelling in the neck, face, chest, or arm on the side of the central line.
Your child feels dizzy or faints.
Your child’s incision or central line site has red streaks that spread away from the area.
Your child’s incision or central line site is bleeding and does not stop.
Your child’s central line is difficult to flush or will not flush.
You do not get a blood return from your child’s central line.
Your child’s central line gets loose or damaged or it comes out.
Your child’s central line leaks when flushed or when fluids are infused into it.

Summary

A central line is a long, thin tube (catheter) that can be used to collect blood for testing or to give medicine through a vein.
Follow specific instructions from your child’s health care provider for the type of device that your child has.
Keep the insertion site of your child’s central line clean and dry at all times.
Keep the tube clamped, unless it is being used.

This information is not intended to replace advice given to you by your health care provider. Make sure you discuss any questions you have with your health care provider.