Central Line

For the London Underground railway line, see Central Line.

In medicine, a central (venous) line (or central venous catheter) is a catheter placed into a large vein.

Description

Most commonly used veins are the jugular vein, the subclavian vein and the femoral vein.

Dependent on its use, the catheter is monoluminal, biluminal or triluminal, dependent on the actual number of tubes (1, 2 and 3 respectively).

The catheter is usually held in place by a suture and an occlusive plaster.

Indications and uses

Indications for the use of central lines include:

• Chemotherapy
• Parenteral nutrition
• Drugs that are prone to cause phlebitis in peripheral veins, such as calcium gluconate.
• Rehydration when peripheral venous access is impossible.

Central venous catheters usually remain in place for a longer period of time, especially when the reason for their use is longstanding (such as total parenteral nutrition in a chronically ill patient).

Complications

Potential complications include:

• Pneumothorax (for subclavian lines) - this is why doctors routinely order a chest X-ray after insertion of a subclavian line.
• Sepsis. All catheters can introduce bacteria into the bloodstream, but CVCs are known for occasionally causing Staphylococcus epidermidis sepsis. A patient with a central line, fever, and no obvious cause of the fever may have catheter-related sepsis. Generally, antibiotics are used, and occasionally the catheter will have to be removed.
• Air embolism
• Haemorrhage