Central Venous Catheters (Central Lines) – Study Notes

1. Importance of Vascular Access

• Critically ill patients often require:

  • IV medications (some cannot be given peripherally).

  • Large volumes of fluids or blood.

  • Special therapies (nutrition, dialysis, monitoring).

• In emergencies: dependable IV access is essential.

2. What is a Central Line?

• A catheter inserted into a large vein close to the heart (SVC or IVC).

• May be single lumen or multi-lumen.

Common Insertion Sites

1. Internal Jugular (IJ) – most common; lowest complication rate.

2. Subclavian – less common; higher risk for pneumothorax.

3. Femoral – often emergent; highest infection risk, ideally removed within 24h.

3. Indications for Central Lines

a. Medications

• Irritant/vesicant drugs (e.g., potassium, vasopressors).

• Continuous vasoactive infusions.

• Multiple infusions at once.

b. Fluids

• Rapid, high-volume resuscitation or massive transfusion.

c. Nutrition

• TPN when enteral feeding not possible.

d. Other Uses

• Hemodialysis access (high flow).

• Poor peripheral access.

• Hemodynamic monitoring (CVP, Swan-Ganz).

• Device access (transvenous pacers, cardiac devices).

4. Types of Central Lines

• Standard central lines: single, double, triple lumen.

  • More lumens = smaller size per lumen.

• PICC lines – inserted in arm, terminate in SVC.

• Tunneled lines – pass under skin; lower infection risk.

• Ports – implanted under skin, used for chemo.

• Hemodialysis lines – large lumens for high flow (200–300 mL/min).

• Introducers/MACs – large-bore, specialty access for resuscitation, pacing, devices.

5. Risks & Complications

1. Bleeding – esp. with coagulopathies or insertion trauma.

2. Pneumothorax/Hemothorax – esp. with subclavian approach.

3. Arterial Cannulation – misplacement into carotid or femoral artery.

   • Confirm with CXR or pressure transducer.

4. Catheter Malposition – retrograde placement into IJ or head.

5. Embolism – thrombus or air embolism (esp. during removal).

6. Infection (CLABSI) – most common complication.

   • Lowest risk: subclavian

   • Moderate: IJ

   • Highest: femoral

6. Central Line Care

Patency & Flushing

• Flush once per shift with 10 mL NS using push-pause technique.

• Avoid flushing vasopressors → bolus effect.

• Never use 3 mL syringes (risk of catheter rupture).

• Occlusion: may require cathflo (tPA).

Infection Prevention

• Do not draw blood cultures from central line (prefer peripheral).

• Dressing:

  • Occlusive, clean, dry, intact.

  • Change q7 days or PRN; gauze → q24h.

  • Sterile gloves, CHG prep, patient & staff masked.

  • Use CHG-impregnated biopatch (blue side up, snug fit).

Line Access

• Minimize manipulations.

• Scrub ports for 15 sec before access.

• Needleless caps, change q72–96h.

• Clamp line when not in use.

7. Insertion & Removal

Insertion

• Bedside sterile procedure.

• Full sterile barrier (gown, gloves, mask, drape, CHG prep).

• Ultrasound guidance preferred.

• Secure with StatLock or sutures.

Removal

• Greatest risk: air embolism.

  • Patient flat.

  • Valsalva maneuver (exhale forcefully).

  • If vented → inspiratory hold.

• Steady pull, apply pressure ≥5 min.

• Occlusive transparent dressing afterward.

• If embolism suspected → place patient left lateral decubitus to trap air in RA.