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How to Place a Central Line

Introduction || The Supplies || The Steps || Video || Overview || Related Articles
References and Resources || Leave a Comment || Search

Introduction and Indications





Central lines are intravenous catheters that are placed into the large veins of the body. They allow the infusion of various medications that cannot be given through a peripheral line (ie: a "normal" IV). They are commonly placed in patients who are in the intensive care unit (ICU).

Most intravenous vasopressors (medications that increase blood pressure) and vasodilators (medications that decrease blood pressure) should only be given through a central line. In addition, 3% sodium chloride infusions and certain chemotherapeutic medications should only be given through a central line because of the risk of damaging the smaller veins of the body. Finally, central lines can be used to measure the patient's central venous pressure; this data gives the clinician an idea about how much intravascular volume the patient has.

It is important to note that central lines are not necessarily the best way to give someone intravenous fluids such as normal saline or lactated Ringer's. 16 gauge peripheral IVs and Cordis® catheters (a different type of central line that is wider and shorter) allow much faster infusion rates than a standard central line.

Central lines are placed in one of the three readily accessible large veins of the body: the femoral, subclavian, or internal jugular veins. Suffice it to say that there are benefits and drawbacks to each location. Central lines come in single lumen, double lumen, and triple lumen varieties depending on the purpose of the line. A lumen is an access port that can be hooked up to intravenous tubing. The more lumens a line has the more "stuff" can be hooked up to it.

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The Supplies

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The Steps

These steps may not be done in this exact order, and quite frankly, some steps belw may be completely ignored, altered, or changed depending on the circumstance. This is meant to serve only as a guide to the placement of a central line.

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Overview

Central lines are placed in patient's receiving intravenous medications that are caustic to smaller peripheral veins. They are placed in either the subclavian, femoral, or internal jugular veins. Infection is a big concern with central line placement so strict sterile technique should be used when placing one. There are different types of central lines; some have multiple ports on them. A chest X-ray should always be ordered if a subclavian or internal jugular vein is placed.

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Related Articles

- How to place an external ventricular drain

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References and Resources

(1) Cherry RA, West CE, Hamilton MC, et al. Reduction of central venous catheter associated blood stream infections following implementation of a resident oversight and credentialing policy. Patient Saf Surg. 2011 Jun 3;5(1):15.

(2) Garrood T, Iyer A, Gray K, Prentice H, et al. A structured course teaching junior doctors invasive medical procedures results in sustained improvements in self-reported confidence. Clin Med. 2010 Oct;10(5):464-7.

(3) Bickley LS, Szilagyi PG. Bates' Guide to Physical Examination and History Taking. Ninth Edition. New York: Lippincott Williams and Wilkins, 2007.

(4) Theodoro D, Krauss M, Kollef M, et al. Risk factors for acute adverse events during ultrasound-guided central venous cannulation in the emergency department. Acad Emerg Med. 2010 Oct;17(10):1055-61.

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