What Is a Central Line, and When Might You Need One? - GoodRx (2024)

Many people are familiar with intravenous (IV) catheters — tiny devices healthcare providers place in a vein so you can get fluids and medication. But most people don’t know there are actually many different types of IVs.

The type of IV catheter providers typically insert into your arm or hand are “peripheral” IVs. That term refers to their insertion into smaller veins that are farther away from the heart. A central line is a larger IV catheter that a provider places into a central vein that’s closer to the body’s core. They usually insert it into the jugular vein (in the neck) or the femoral vein (in the groin).

Central lines have several benefits over smaller IVs. Importantly, they can deliver large doses of medications quite quickly. But there are a variety of reasons you may need a central IV. Here we’ll discuss more details about central lines and the different types, including why you may need one, how providers insert them, and potential risks.

Why would someone need a central line?

A central line has several benefits over a regular peripheral IV. So there are a few different scenarios where a provider may recommend it. Some benefits of central lines are that they can:

• Last longer: They’re a better option when you need a certain medication for an extended period of time (like chemotherapy or antibiotics).

• Avoid repeat IV sticks: This is helpful when someone needs weekly chemotherapy infusions, for example.

• Safely deliver strong medications: They’re particularly helpful for medications that affect the way the heart beats or the blood vessels squeeze.

• Deliver multiple medications at the same time: This is important when someone is very sick.

• Quickly deliver a large amount of fluids: This is helpful in emergency situations when someone has a dangerously low blood pressure or is losing a large amount of blood.

• Deliver long-term IV nutrition: This is also known as “total parenteral nutrition” (TPN).

• Provide IV access when a peripheral IV is difficult: This can happen when someone is very dehydrated, has small or scarred veins, or has to get IVs often.

How is a central line inserted?

Healthcare providers might insert, or “place,” a central line when someone is admitted to the hospital. Different types of providers can perform the procedure. For example, an anesthesiologist might do it in the operating room. Or a critical care or emergency provider might place a central line in the intensive care unit (ICU) or emergency room (ER).

In many cases, the person who needs a central line isn’t awake for the procedure. This is either because they’re under anesthesia in the OR, or they’re sedated on a ventilator.

If you’re awake for the procedure, it can be uncomfortable but not painful. Here are the typical steps in the procedure:

• Your provider will determine the best location on your body to insert the central line. They examine your skin and use an ultrasound to look at your veins.

• Once your provider finds the best spot, they clean your skin with an antiseptic solution. They may also place a large sheet over the surrounding area, which has a hole in the middle so they can do the procedure. This is so everything stays as sterile as possible.

• Then your provider uses a very small needle to inject numbing medication just underneath the skin. Sometimes the medicine burns for a few seconds as it takes effect, but it makes the rest of the procedure much more comfortable.

• Once your skin is numb, your provider inserts the IV into your vein. They use a needle to get the IV in the right place, although nothing will feel sharp or painful. But you may feel some pressure during the procedure.

• Once the IV is in your vein, the provider removes the needle and either tapes or stitches the IV so it stays in place. Then a quick X-ray confirms that everything looks good before actually using it.

From start to finish, the procedure usually takes about 20 to 30 minutes. But most of that time is to get everything set up and sterile. The amount of time to actually insert the IV is much shorter.

After the procedure, you might feel like you have a bulky piece of plastic taped to your skin. But the IV catheter is very soft and flexible, and there’s not actually a needle in your body. So you won’t experience any pain associated with it.

Why is a central line riskier than a peripheral IV?

Central lines are usually safe, but they do come with risks and potential complications that occur in about 5% of cases. Complications of central lines include:

• Bleeding: Since large catheters go into larger veins, the risk of bleeding is higher compared to a small peripheral IV. You can control any excess bleeding by holding pressure on the area for a few minutes.

• Injury of an artery: Arteries are right next to veins. And it’s a problem if an IV goes into an artery instead of a vein, because arteries can bleed quickly. Thanks to ultrasound, this complication is increasingly rare and occurs less than 1% of the time.

• Collapsed lung (pneumothorax): This happens if the needle that inserts the IV punctures the chest cavity, causing air to build up around the lungs. The chance of this happening is less than 1%.

• Blood clot: These can form inside the catheter, causing a blockage that makes it hard to pass medication or fluid through the catheter. Sometimes providers can put a blood thinner, like heparin, into the catheter to help break up the clot.

• Infection: Central lines can lead to infections in the skin at the site of the catheter or in the bloodstream. Sterile technique minimizes this risk. But IV antibiotics can treat potential infection (the catheter may need replacement).

• Arrhythmia: Abnormal heart rhythms can happen during the procedure because the instruments used to insert the catheter can “tickle” the heart. Usually this stops on its own when the wire is pulled back, so it doesn’t cause any problems or symptoms.

PICC lines and ports

You may have heard of other types of IVs called “peripherally inserted central catheters” (PICC lines) and “ports.” These are actually special types of central lines, designed so you can leave the hospital but still receive IV treatments.

A PICC line is “peripherally inserted” through a smaller vein in the arm. Although the name may seem to suggest otherwise, it’s actually a type of “central” catheter. That’s because it’s long enough for the tip to end up in a larger vein, just like a traditional central line.

A provider can easily place a PICC line at the bedside before you leave the hospital. The most common reason for a PICC line is long-term IV antibiotic treatment.

A port is a little bit different. It’s a small button-like device that a provider places under the skin, usually on the chest. It connects to a catheter that inserts into a central vein. To use it, a provider inserts a little needle through the skin and into the port underneath. This allows access to the vein.

Providers place ports in a small surgical procedure. Once in place, you can feel a little bump under the skin — but nothing will stick out of your skin. You can get a range of medications through a port, but chemotherapy infusions are the most common.