The question of whether nurses place central lines has a complex answer that depends entirely on the type of catheter and the nurse’s specialized training. While the majority of nurses do not perform the insertion procedure, a specific group of highly trained nurses are responsible for placing one of the most common types of central venous access devices. The nurse’s involvement shifts from insertion to comprehensive management once the line is in place.
What is a Central Line and Who Traditionally Places Them
A central line, or central venous access device (CVAD), is a long, flexible catheter inserted into a large vein to deliver medications, fluids, or nutrition directly into the central circulation near the heart. This differs significantly from a peripheral intravenous (IV) line, which is a much shorter catheter placed into a smaller vein in the arm or hand and is generally used for short-term treatments. Central lines can remain in place for weeks or months, making them suitable for long-term therapies like chemotherapy or prolonged antibiotic courses.
Traditional central venous catheters (CVCs) are often inserted into major veins in the neck, chest, or groin, such as the jugular, subclavian, or femoral veins. Due to the proximity of these veins to major organs and the higher risk of complications like pneumothorax or arterial puncture, the placement of these CVCs requires a physician, such as an intensivist, surgeon, or interventional radiologist. Advanced Practice Providers, including Nurse Practitioners and Physician Assistants, may also perform these insertions depending on their specialized training and hospital protocol.
The procedure is performed under sterile conditions, often using ultrasound guidance to locate the vein and confirm correct placement with an X-ray.
Specialized Nursing Roles in Line Insertion
A specific category of central line, the Peripherally Inserted Central Catheter or PICC line, is routinely placed by specialized Registered Nurses (RNs). These nurses, often referred to as Vascular Access Nurses or PICC Nurses, undergo extensive training and certification to perform this procedure safely. Unlike traditional CVCs inserted near the torso, a PICC line is inserted into a peripheral vein in the arm and then threaded up into the large central vein near the heart.
These specialized nurse-led teams also commonly place Midlines, which are longer than a standard peripheral IV but shorter than a PICC line, ending in a vein in the upper arm rather than the heart. The insertion process for PICC lines and Midlines is often guided by ultrasound technology. Additionally, some nurses utilize electrocardiogram (ECG) technology to precisely confirm the catheter tip’s location near the junction of the superior vena cava and the right atrium, avoiding the need for a follow-up chest X-ray in some cases.
The Nurse’s Primary Role in Central Line Management
For the vast majority of bedside nurses, their professional responsibility involves the ongoing care and maintenance of the central line once it is placed. This daily management is a primary factor in preventing complications and ensuring the line remains functional for the duration of the patient’s treatment. Nurses are responsible for administering medications and fluids through the line, which involves rigorous protocols for disinfecting the injection ports and adhering to specific flushing guidelines.
A major component of the nurse’s role is infection prevention, which includes performing sterile dressing changes at the insertion site. This involves using an antiseptic solution, such as chlorhexidine, and applying a sterile occlusive dressing to minimize the risk of bacteria entering the bloodstream, a serious complication known as a Central Line-Associated Bloodstream Infection (CLABSI).
Nurses also monitor the patient and the line site for signs of other complications, including localized bleeding, swelling, or symptoms of a blood clot (thrombosis). They must also regularly assess whether the line is still necessary, advocating for its removal as soon as it is no longer indicated for treatment to reduce the overall risk of infection and other complications.