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Central Venous Catheter / Central Line

What is a central line? 

A central line is a sterile tube placed in a large vein that goes to the heart. The IV medication, fluid and nutrition that your child needs will be given through your child’s central line.

There are three types of central lines: 

1. A Hickman or Broviac catheter which is tunneled under the skin of the chest and enters a large vein in the neck. This line is placed in the operating room and is for children who need intravenous (IV) access for months or years.
2. A PICC line which enters the vein in the bend of the elbow or higher up the arm. This line is placed by trained nurses or other health professionals. PICC lines are for children who need IV access for weeks to months
3. A port which has a fluid reservoir placed under the skin of the chest and a tube connected to the reservoir which enters a large vein in the neck. Ports are entirely under the skin. When your child needs IV access, the reservoir is entered with a special needle which is poked through the skin into the port. Local numbing medicine can be put on the skin before the needle is inserted. Ports are placed in the operating room and are for children who need IV access for months or years. 

Why does my child need a central line?

Your child needs medication, nutrition or fluids that must be given often, or for a long period of time. Using a large vein means these things can be given faster and with less damage to the vein. Also, having a central line means your child will not have needle sticks to start an IV every time s/he needs medicine, nutrition or fluids. 

What care is needed for the central line?

The care of the line will depend on the type your child gets. Your health care provider will give you detailed instructions on its care. All central lines need very clean or sterile dressing changes on a regular schedule and flushing to keep them from clogging. In general:

• The central line must be kept clean, dry and safe. 
• It should be protected from germs and dirt. 
• It should be pinned safely to your child’s clothing so that it does not get pulled out.
• The dressing that covers your child’s central line should always be stuck to the skin all the way around. If it lifts up or gets wet underneath, it must be changed. 
• The central line needs to be flushed (have fluid put in it to keep it working) on a schedule that will be in your instructions. 
• You will be taught how to do the dressing change and flushing or you will be told who will do the central line care.  

Try to keep sharp objects like pins or scissors away from your child’s central line. Your health care provider will tell you what to do or whom to contact if the central line starts to leak or is broken. If this happens, it is an emergency and must be taken care of immediately. A broken line can allow germs to get into your child’s bloodstream and cause an infection. 

Contact your doctor or nurse if you notice any of the following:

• Redness, swelling, drainage, or tenderness where the catheter 
• enters your child’s skin
• Fever over 101F.
• If you are unable to flush the catheter or it is harder to flush than usual.
• Pain or discomfort when your child is having any fluids or medications put into the central line.        

Please reproduce and distribute this sheet to your surgery families. This teaching sheet can also be downloaded at www.APSNA.org.

Copyright 2006, Melanie A. Kenney.  Copied with permission by Jones and Bartlett Publishers, Sudbury, MA."