Is an Internal Jugular Central Line Tunneled
An internal jugular central line is tunneled under the skin and typically placed into the neck. Internal jugular central lines are most commonly used in children

A central venous line (CVL) is a long, thin, flexible tube that is inserted into a vein to allow medicine into the body. An internal jugular central line is tunneled under the skin and typically placed into the neck.

Internal jugular central lines are most commonly used in children when venous access is required for more than 7-14 days.

How is an internal jugular central line inserted?

With CVLs, imaging guidance is essential to increase the likelihood of successful cannulation and reduce the risk of complications.

Tunneling an internal jugular central line involves inserting the tip of the catheter into the internal jugular vein with the guidance of ultrasound and fluoroscopy. The catheter is positioned in the large vein (superior vena cava) leading to the heart. This placement allows for a better combination of intravenous fluids and medicines. The rest of the central line is tunneled under the skin, from the neck to the chest area.

After the procedure, a chest X-ray is done to verify the placement of the CVL.

Why is an internal jugular central line preferred in children?

An internal jugular central line is used in children who require intravenous (IV) therapy for a long period of time. IV therapy may include medications, chemotherapy, and IV fluids.

Regular IV lines, which are usually inserted into a vein in the hand, arm, foot, or leg, can be painful and damaging to a child's veins if inserted for long periods of time. CVLs reduce the pain and make it easier for a child to receive IV therapy. 

An internal jugular central line can also be used to collect blood samples for total parenteral nutrition (TPN) and some treatments such as dialysis or stem cell collection.

When are CVLs done?

CVLs are done in the following cases:

  • Need for long-term venous access
  • Inability to obtain peripheral venous access
  • Intravenous infusion of:
    • Medications
    • Concentrated or irritating fluids
    • High flows or large fluid volumes
  • Monitoring of central venous pressure
  • Hemodialysis or plasmapheresis

How long should an internal jugular central line be allowed to stay in?

CVLs can stay in for months or years if they are working well and remain problem-free. Your doctor will determine how long the CVL can stay in.

If your doctor determines that the CVL is no longer needed, they will plan for a removal procedure, which typically takes 30 minutes and can be done under sedation or general anesthesia. Food restrictions on the day of the procedure are similar to when the CVL was inserted.

What are the risks of a CVL insertion?

A central venous line (CVL) insertion is a low-risk procedure. Risks may increase, however, depending on your condition, age, and health.

Risks may include:

  • Bleeding or bruising
  • Pain or discomfort
  • Infection
  • Clotting
  • Air in the lungs or veins
  • Irregular heart rhythm
  • Breakage of the catheter
  • Movement of the catheter
  • X-ray exposure
  • Vein perforation
  • Nerve or artery damage

What are possible complications of an internal jugular central line?

The most common acute complications of CVL placement include:

  • Cardiac dysrhythmias
  • Vascular injury
  • Bleeding
  • Catheter malposition
  • Pneumothorax

Less common complications include:

  • Stroke
  • Airway compromise
  • Air embolism
  • Pericardial tamponade (bleeding around the heart)
  • Loss or entrapment of the guide wire

The most common long-term complications include infection and thrombosis.

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Medically Reviewed on 3/28/2022
References
Image Source: Medscape Images

Flick AI, Winters R. Vascular Tunneled Central Catheter Access. [Updated 2021 Dec 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022. https://www.ncbi.nlm.nih.gov/books/NBK557614/

Govindarajan KK. Central Venous Access via Tunneled Anterior Approach to Internal Jugular Vein. Medscape. https://emedicine.medscape.com/article/80298-overview