A central line is a thin, flexible tube placed into a large vein that leads to the heart. Unlike a standard IV, which goes into a small vein in your hand or arm and lasts only a few days, a central line can stay in place for weeks, months, or even years. The tube is threaded through a vein until its tip sits in the superior vena cava, the large vein that carries blood into the heart. This position allows medications to mix quickly with a high volume of blood, which is essential for treatments that would damage smaller veins.
Why a Central Line Is Needed
Certain medications, particularly chemotherapy drugs, are too harsh for the small veins in your hands and arms. A central line delivers them into a large, high-flow vessel where they’re diluted almost immediately. The same logic applies to concentrated nutrition given directly into the bloodstream (known as TPN) and to powerful medications used in emergency or critical care settings. Some contrast agents used for CT or MRI scans also require the high-pressure injection a central line can handle.
Beyond specific medications, central lines reduce the number of needle sticks you need. If you’re facing weeks of IV antibiotics, regular blood draws, or repeated transfusions, a central line gives your care team a single reliable access point. This is especially helpful for children, who may have small or difficult-to-access veins.
Types of Central Lines
Not all central lines look the same or go in the same way. The type you get depends on how long you’ll need it, what treatments you’re receiving, and your overall health.
- Non-tunneled catheter: Inserted directly into a vein in the neck, chest, or groin and used for short-term needs, often in hospitals or emergency settings. It’s the quickest to place but carries a higher infection risk over time.
- PICC line (peripherally inserted central catheter): Threaded through a vein in your upper arm until the tip reaches the large vein near your heart. PICCs are common for treatments lasting several weeks to a few months, like extended antibiotic courses. They cost significantly less than surgically placed options (around $500 versus $2,500 on average) and patients generally find them easier to manage at home.
- Tunneled catheter (such as a Hickman line): Surgically placed under the skin of the chest before entering a vein. The tunnel creates a barrier that helps prevent infection. These are used when access is needed for months, such as during stem cell transplantation or long-term chemotherapy.
- Implanted port (port-a-cath): A small reservoir placed entirely under the skin, usually on the chest. To use it, a nurse pushes a special needle through the skin into the port. When it’s not being accessed, nothing is visible outside the body, so you can shower and swim without covering it. Ports are designed for treatments that happen in cycles with breaks in between.
How a Central Line Is Placed
The most common insertion sites are the internal jugular vein in the neck and the subclavian vein just below the collarbone. For PICC lines, the entry point is a vein in the upper arm. In some situations, a vein in the groin is used.
Before insertion, the area is numbed with a local anesthetic. For ports and tunneled catheters, you may receive sedation. Your care team uses ultrasound to locate the vein and guide the needle, then threads the catheter through until the tip reaches the superior vena cava. A chest X-ray confirms the tip is in the right position. The procedure typically takes 30 minutes to an hour, depending on the type of line.
Risks and Complications
The most talked-about risk is infection. Central line-associated bloodstream infections have been a major focus of hospital safety efforts for years, and the rates continue to drop. CDC data from 2024 shows a 9% decrease in these infections compared to the previous year, with improvements in both ICU and general hospital wards. Infection rates for PICC lines and tunneled catheters are comparable, roughly 1.5 to 4 infections per 1,000 catheter-days.
Mechanical complications during insertion are less common but worth knowing about. A collapsed lung (pneumothorax) can occur when a catheter is placed through the chest, though it happens in only about 0.5% of cases. The risk is higher with the subclavian vein (2.3%) than the internal jugular vein (0.1%). Blood clots near the catheter tip are another possibility, occurring in roughly 1.5 to 3% of cases depending on the type of line.
Signs of a problem include fever, redness or swelling at the insertion site, pain along the catheter path, shortness of breath, or a line that stops working. These warrant prompt medical attention.
Caring for a Central Line at Home
If you go home with a central line, keeping the site clean and dry is the most important thing you can do to prevent infection. Transparent dressings over the insertion site are typically changed once a week. Gauze dressings need to be changed every two days. If a dressing becomes wet, loose, or visibly soiled, it needs to be replaced right away.
Showering requires some planning. The line and dressing must be covered with a waterproof barrier, like plastic wrap or a plastic bag, sealed around the edges with tape so no water can seep in. You should never submerge the line in a bath, pool, or any body of water. If you’re washing your hair, tilt your head back so water flows away from the line rather than over it. The one exception is an implanted port that isn’t currently accessed: since nothing breaks the skin surface, it doesn’t need to be covered.
Your care team will also teach you (or a caregiver) how to flush the line with a sterile solution to keep it from clotting. The line’s clamps should stay closed when not in use. Avoid pulling or tugging on the catheter, and secure it to your body with tape or a clip to prevent accidental dislodging.
How a Central Line Is Removed
Removal is a bedside procedure, but it’s done carefully to prevent air from entering the bloodstream through the catheter tract. You’ll be positioned lying flat or with your head slightly lower than your heart, which increases pressure in the veins and makes it harder for air to be drawn in. All ports on the catheter are clamped before removal.
As the catheter is pulled out in a slow, steady motion, you may be asked to bear down as if straining, which further raises the pressure in your chest veins. Pressure is held on the site for one to five minutes afterward, and then it’s covered with an airtight dressing, usually gauze coated with petroleum jelly under a transparent film. That dressing stays in place for at least 24 hours and is changed daily until the site heals. You’ll be asked to lie flat for about 30 minutes after removal to give the tract time to begin closing.
The removal itself is quick and generally painless. For implanted ports, a small incision is needed to retrieve the device from under the skin, which may require local anesthesia and a few stitches.