Central lines

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What is a Central Venous Catheter?

Central Venous Catheter is a tube which is passed through a vein to reach the thoracic (chest) portion of the Vena Cava (the large vein returning blood to the heart) or into the heart. The Central Venous Catheter is usually inserted for weeks to months to avoid the need for repeated needle insertion or injections. They are used for a variety of different reasons such as:
• Administration of strong solutions (such as chemotherapy)
• Administration of drugs or medicines (over long period of time)
• Supportive therapy such as giving blood transfusion or Total Parental Nutrition (TPN)
• Blood sampling There are several types of Central Venous Catheter:

1. Peripheral Inserted Central Venous Catheter (PICC)

A needle is used to put the PICC line into a vein in the arm, and the catheter (or line) is threaded through the needle to end in a large vein in the chest near the heart.

2. Chemoports

Ports are placed under the skin of the chest or arm during surgery. The drum has a silicone septum (self-sealing membrane) across the top and special needles are stuck through the skin into the septum to use the port. There are no external tubes or parts.

3. Hickman’s Catheter

The Hickman catheter is a soft tunneled tube(s) usually placed in the chest and has several inches of catheter outside the skin. It is more durable and lasts longer than the PICC line.

4. Apheresis Catheter

A temporary line may be required for patients undergoing apheresis (e.g. for peripheral blood stem cell harvest).  This line is commonly inserted in the neck and is the same catheter used by patients undergoing dialysis.  Insertion is via a simple puncture in the neck. These catheters are usually kept in place for a few days up to about a week.

All the above devices (1-4) can be inserted as a minor procedure in the Radiology department by Interventional radiologists.  Local anaesthesia is used and the procedure is relatively painless. You do not need to undergo surgery under General anaesthesia.

Care of the Central Venous Catheter

It is important to take good care of the Catheter because there is a risk of getting infection. Avoid
vigorous activities such as contact sports or swimming.

The catheter site should be cleaned and the dressing changed regularly to prevent
infection. The cleaning can be done by nurses at the hospital or caregivers at home.

The PICC and Hickman catheter has to be flushed with an anticoagulant (heparin saline)  twice a week to reduce the risk of catheter blockage. Chemoports need less frequent flushing, usually every 3 months or so.

Observe for any signs of complications and see your doctor as soon as possible. These signs

• Redness, pain or swelling around the catheter site
• Pain or tenderness along the path of the catheter
• Drainage from the skin around the catheter
• Sudden fever, chills or rigors
• Bleeding at site or along the catheter
• Catheter falling out