Introduction

A central venous line (CVL), also known as a central venous catheter (CVC), is a medical device used to provide direct access to a large vein, typically in the chest, neck, or groin. These catheters are essential for administering medications, fluids, and nutrition, as well as for monitoring central venous pressure and facilitating hemodialysis.

Depending on the duration of use, risk of infection, and intended purpose, different types of central venous lines are available.

Types of Central Venous Lines

Central venous catheters are categorized based on their insertion technique, duration of use, and whether they are tunneled or non-tunneled.

1. Non-Tunneled Central Venous Catheters

Purpose: 

Short-term use, typically in critical care or emergency situations.

Insertion: 

Directly into a central vein (e.g., subclavian, jugular, or femoral vein) without a subcutaneous tunnel.

Common Uses:

Emergency venous access

Administration of high-risk medications (e.g. vasopressors, chemotherapy)

Hemodynamic monitoring

Pros: 

Quick insertion, ideal for acute care.

Cons: 

Higher infection risk, not suitable for long-term use.

2. Tunneled Central Venous Catheters

Purpose: 

Long-term intravenous access, reducing infection risk by tunnelling under the skin.

Insertion: 

The catheter is placed under the skin before entering a central vein, with a Dacron cuff promoting tissue growth for stability.

Common Types:

Hickman Catheter – Used for chemotherapy and total parenteral nutrition (TPN).

Broviac Catheter is similar to a Hickman but with a smaller lumen, often used in pediatric patients.

Groshong Catheter – Features a valve to prevent blood reflux, reducing the need for heparin flushing.

Pros: 

Lower infection risk than non-tunnelled CVCs, suitable for long-term use.

Cons: 

Requires surgical placement, periodic maintenance needed.

3. Peripherally Inserted Central Catheters (PICC Lines)

Purpose: 

Medium- to long-term venous access for extended treatment.

Insertion: 

Inserted into a peripheral vein (usually in the arm) and advanced into the superior vena cava.

Common Uses:

Long-term antibiotic therapy

Chemotherapy

TPN

Pros: 

Lower complication risk than tunnelled CVCs, easily inserted at the bedside.

Cons: 

Can occlude or dislodge easily, may not be suitable for all patients.

4. Implanted Ports (Port-a-Caths)

Purpose: 

Long-term intermittent venous access, often for chemotherapy.

Insertion: 

A small reservoir (port) is implanted under the skin and connected to a catheter leading into a central vein. The port is accessed with a special needle.

Common Uses:

Chemotherapy

Long-term intermittent IV treatments

Pros: 

No external components, minimal daily maintenance, and low infection risk when not accessed.

Cons: 

Requires minor surgery for placement and removal.

5. Dialysis Catheters

Purpose: 

Specialized CVCs are used for hemodialysis or plasmapheresis.

Insertion: 

Can be non-tunnelled (for short-term dialysis) or tunnelled (for long-term dialysis).

Common Types:

PermCath – A tunnelled catheter used for long-term dialysis.

Quinton Catheter – A non-tunnelled catheter for temporary dialysis access.

Pros: 

Provides reliable access to dialysis.

Cons: 

High infection and clotting risk, requiring strict maintenance.

Choosing the Right Central Venous Line

The choice of a central venous catheter depends on:

Duration of use: 

Short-term (non-tunnelled) vs. long-term (tunnelled, PICC, port).

Infection risk: 

Tunneled catheters and implanted ports reduce infection risk.

Patient condition: 

PICCs may be preferred in patients with limited venous access.

Intended use: 

Chemotherapy, TPN, hemodialysis, or emergency access dictate the catheter type.

Complications and Management

While CVCs are essential for patient care, they carry potential risks:

Infection (Catheter-Related Bloodstream Infections – CRBSI): 

Strict sterile insertion and maintenance reduce infection risk.

Thrombosis: 

Blood clots can form around the catheter, requiring anticoagulation or catheter replacement.

Catheter Malfunction: 

Occlusion or migration may interfere with function.

Pneumothorax: 

A rare but serious complication of subclavian vein insertion.

Conclusion

Central venous lines are a critical tool in modern medicine, providing reliable venous access to a variety of medical treatments. The choice of catheter depends on the patient’s condition, expected duration of use, and risk factors. Proper care and maintenance are essential to prevent complications and ensure optimal function.

FAQs

1. What is a central venous line (CVC)?

A central venous line (CVC) is a catheter inserted into a large vein to provide long-term access to medication, fluids, blood draws, or dialysis. It is commonly placed in the neck (internal jugular vein), chest (subclavian vein), or groin (femoral vein).

2. Why is a CVC used instead of a regular IV line?

A CVC is used when:

Long-term IV therapy is needed (e.g., chemotherapy, total parenteral nutrition).

Frequent blood draws are required.

Medications that are irritating to smaller veins need to be administered.

Large volumes of fluids or blood products must be given quickly.

3. What are the different types of central venous catheters?

The main types include:

Non-tunnelled CVCs are used in emergencies or ICU settings.

Tunneled CVCs (e.g., Hickman, Broviac, Groshong) For long-term therapy.

Peripherally Inserted Central Catheters (PICC Lines) Inserted in the arm for medium- to long-term use.

Implanted Ports (Port-a-Cath) – A port placed under the skin for intermittent access.

Dialysis Catheters Specialized catheters for hemodialysis.

4. How is a central venous catheter inserted?

A CVC is placed by a doctor using ultrasound guidance and sterile techniques. It is inserted through a large vein, and in some cases (e.g., tunnelled catheters), a portion is tunnelled under the skin for stability and infection prevention.

5. How long can a central venous line stay in place?

Non-tunneled CVCs – Days to a few weeks.

Tunnelled CVCs and PICCs – Weeks to months.

Implanted Ports – Months to years.

Dialysis Catheters are variable, depending on need and complications.

6. What are the risks and complications of a CVC?

Infection (catheter-related bloodstream infections – CRBSI)

Blood clots (thrombosis)

Catheter occlusion or malfunction

Air embolism (air entering the bloodstream)

Pneumothorax (lung collapse) during placement

7. How is a CVC cared for to prevent infection?

Hand hygiene before handling the line.

Regular dressing changes using sterile techniques.

Flushing the catheter with saline or heparin as instructed.

Avoiding unnecessary handling of the catheter.

8. Can I shower or bathe with a central line?

It depends on the type of CVC:

Non-tunneled and PICC lines – Keep them dry; use a waterproof cover.

Tunnelled catheters and ports are more resistant to water exposure but still require caution.

Implanted ports – Safe to shower when not accessed.

9. How is a CVC removed?

Non-tunneled CVCs and PICCs are removed at the bedside by a healthcare professional.

Tunnelled CVCs and Ports – Require minor surgery for removal.

10. What should I do if my CVC is leaking, blocked, or painful?

Do not use the catheter.

Contact a healthcare provider immediately.

If the catheter is leaking, clamp it above the leak and seek medical attention.