What are central venous catheters?

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CVCs are present in a number of settings, including hospitals, long-term care facilities, and outpatient facilities. A person may also need a CVC after discharge from a hospital stay or for long-term treatment for conditions such as cancer.

A person may need a CVC for the following reasons:

• to administer medications, such as antibiotics, chemotherapy, and pain medications
• to provide nutrition
• to conduct certain medical tests

A medical professional inserts the CVC in a large central vein in one of the following places:

• chest
• neck
• arm
• groin

They then guide it until it rests in a large vein either near the right side of the heart or directly into the heart.

There are different kinds of CVCs.

Implanted ports

Implanted ports are ports that medical professionals place under the skin, typically in the chest. In some cases, medical professionals may place them under the arm.

To use the port, a healthcare professional pushes a needle through the skin and into the port. This port needle connects with the tubing of the port to deliver treatment.

Other names for implanted ports are portacaths and subcutaneous ports.

Tunneled catheter

Tunneled catheters travel under the skin, away from the point of entry into the vein. These can stay for weeks to months and provide long-term access for intravenous therapy upon discharge from the hospital.

Other names for tunneled catheters include:

• Groshong catheters
• Hickman catheters
• Broviac catheters

Non-tunneled catheters

Unlike a tunneled catheter, a non-tunneled catheter inserts directly into the large vein instead of traveling through the vein under the skin.

They are most common in acute and emergency situations because of their easy insertion. However, they have a short duration of use and require changing within a few days to a week.

Peripherally inserted central catheters (PICC)

PICC lines involve placing a flexible tube in the arm and passing it through a vein that leads to the superior vena cava (SVC) near the heart.

Its end sticks out of the arm through the skin with a clear dressing over it. The PICC may remain for weeks or months. It allows doctors to administer medication such as antibiotics or chemotherapy drugs.

Learn more about PICC lines.

A person may need a CVC if:

• they have veins that are fragile or hard to find
• it is not possible to place an IV in one or both arms
• treatment will last for at least a number of months
• there is damage to the veins from previous treatment
• they need several infusions at once
• they need total parenteral nutrition (TPN)
• they require medication that is too strong or will cause skin damage if it leaks outside a peripheral IV
• they need several infusions at once

Healthcare professionals may also use a central line for individuals who need medications that could cause phlebitis (inflammation) or hardening (sclerosis). It is also necessary for individuals who need monitoring of:

• central venous pressure
• pulmonary artery pressure
• central venous oxyhemoglobin saturation

CVCs require fewer needle sticks, which helps prevent damage to the peripheral veins.

As medications go directly to the large vein near the heart, CVCs may also reduce pain and discomfort.

They also accommodate large amounts of fluids and medications that might not go through regular IVs. Depending on the type of CVC, they can also stay in place longer — from weeks to months — making them ideal for long-term treatments.

The procedure for inserting CVCs depends on the type a person needs.

For PICCs and non-tunneled CVCs, it typically involves cleaning and numbing the area before puncturing the skin with a needle. Medical professionals may use ultrasound to find the vein and take an X-ray to verify proper positioning following the procedure.

They will then make a small incision in the vein to insert the tube into it before moving, or “threading,” it through the vein.

For a tunneled CVC, a doctor makes two incisions: one at the entry site where the catheter enters the body and one at the exit site or the area where the catheter enters the vein.

Placing implanted ports is a short surgical procedure that involves creating two incisions: one in the neck to reach the large vein and one in the chest, arm, or abdomen to hold the port in place.

Depending on the type of CVC, a person may need a chest X-ray to ensure proper placement and no complications.

If a person is going to receive treatment at home, they will receive information about how to care for their central venous catheter.

Possible risks of CVCs can occur during and after the procedure. These risks can include:

• bleeding
• pain
• infection
• blood clots
• blockage due to clotted blood
• accidental removal of the CVC
• injury to the windpipe or trachea
• puncture to an artery
• puncture to the lung with or without collapsed lung (pneumothorax)
• central vein stenosis
• air embolism
• arrhythmia
• moving of the CVC, which will require repositioning

Medical professionals will take steps to reduce these risks. If any do occur, they will be able to recommend treatments or reposition the CVC as necessary.

Medical professionals insert more than 5 million CVCs in the United States every year.

Around 8% of people in hospitals require central venous access.

Here are some frequently asked questions about CVCs.

What are the four main types of central venous catheters?

The four types of CVCs are implanted ports, tunneled catheters, non-tunneled catheters, and PICCs.

What is the difference between a PICC line and a CVC?

A PICC line is a type of CVC. CVCs are catheters that enter a large vein near the heart or directly into the heart. A PICC line is a CVC with a catheter that passes through a vein in the arm, chest, or abdomen and leads to the large vein near the heart.

Central venous catheters (CVCs) are medical devices common in acute and critical care settings. They can facilitate long-term treatment, continuous monitoring, and certain types of procedures.

CVCs also come with risks such as bleeding, structure injury or damage, and infection. Despite these risks, their many benefits make them integral to medical care.