Central Lines

What is a central line?

A central line is a long term IV line that instead of going into your peripheral veins like a normal IV, it goes into much larger veins, generally right near your heart. There are several different kinds, but in general the 3 most common are PICC lines, tunneled catheters, and portacaths.

When are central lines used?Central lines are generally used if you need continuous or long term access, or if you are getting infusions that are too caustic for the peripheral veins to handle. A common example of this is for cancer treatment, which requires frequent access and medications that can be hard on veins.

What are some of the risks of having a central line?

As with any medical procedure or treatment, there are risks. These include blood clots, embolisms, infection, and misplacement. When you are looking into a central line, you and your doctor need to decide whether the benefits outweigh the risks. Different people will have different likelihoods of complications (example: someone who has a suppressed immune system may have a greater chance of infection).

What type of line is best for me?

This is a question that only you and your doctor can answer. And you may find that some doctors really like or dislike specific types of lines. It depends on you and what your unique needs are. When you discuss placement with your doctor, make sure that they know what you need and are adjusting for that. For example, it might not make sense to place a permanent port into someone who is only needing a two week course of medication.

Can you shower with a central line?

A dressing for a tunneled line (hickman, broviac) or a PICC line should not get wet, as it can increase chances for infection. When a port is not accessed (there is no needle or dressing), you can swim freely, however when a port is in use the dressing should not get wet. There are different products that can be used to cover lines for showering, including aquqguard, hydroshield, and others. For PICC lines, dry pro covers are popular, and some find that a cast cover such as this one will be the best for them. If at some point your dressing does get wet, call your home health nurse and get the dressing changed as soon as possible.

How long can a central line stay in?

This depends on a variety of factors. Some people have lines for years, where others have complications. In general, PICC’s can stay in for weeks to months, however, it’s not unheard of for PICC’s to last much longer. Implanted ports and tunneled lines can stay for months to years. The best way to have your line last as long as possible is to care for it as carefully as possible.

How are central lines placed?

Each kind of line has a different method of placement. And remember that this is all individual, so discuss the plan for the placement of your line with your doctor.

PICC lines are generally placed bedside, using an ultrasound. They also can be placed in radiology. Sometimes they are placed using mild sedation, and often use a local anesthetic to numb the site before placement. Most PICC placements are quite straightforward. Remember: if something doesn’t feel right, let your care team know immediately. More information on PICC line placements can be found here.

Tunneled catheter placements can be placed with either sedation, general anesthetic, or local anesthetics (such as lidocaine). Ultrasound and fluoroscopy are used in order to guide the line into the vein. More information on tunneled line placement can be found here. After the procedure, there may be some bruising and soreness.

Portacaths are placed with some form of anesthesia or sedation, and often use local anesthetics as well. An incision is made, and the line is threaded up into a large vein and a “pocket” is made for the port. More information can be found here.

Where are central lines placed?

The most common sites are the upper chest or upper arm. However, lines can also be placed in the legs, abdomen, arm, or back. As long as the line can be threaded into a central vein, the location of the site can vary. It’s best to discuss with your doctor or surgeon to determine what will work for you. When deciding on a site, take into account your activity level or think about how having a line in that area will impact daily life. Sites are limited to where you have viable veins, and so it’s a very individual decision.

My skin is sensitive. Are there hypoallergenic dressings?

Yes. Unfortunately, with dressings, it’s a lot of trial and error. Here is a list of possible dressings to try: IV3000, IV Clear,

What is a “power port” or a “power line”?

A power port or a power line is a line or port that can handle power injected (high pressure) contrast  for CT scans. If your line cannot do pressure and you require a CT scan with contrast, a peripheral IV may be placed.

 

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