Central line placement under ultrasound guidance helps with more accurate placement of a central venous catheter while lowering the risk of associated complications. Ultrasound guidance helps provide accurate anatomy of the site where the catheter is to be placed and thus results in fewer puncture attempts.
During an ultrasound-guided central line placement, the following steps may occur:
- Pain medications and sedatives are administered.
- The patient lies on the couch with the head slightly lowered for better exposure of the neck structures (for placing a central line in the blood vessels of the neck).
- The doctor stands at the head end of the patient and cleans the neck with an antiseptic solution.
- The cannulation site is numbed using a local anesthetic.
- The ultrasound probe is used to obtain images of the neck vessels and other important structures in the neck.
- After identifying the blood vessel to be cannulated, the doctor inserts a needle into the skin to create a small tunnel.
- Then, the central line is placed in the tunnel so that the tip of the catheter rests in a large vein.
- The catheter is secured in place using sterile dressing at the entry site.
- The patient’s vitals are monitored in the recovery room.
- The patient may be discharged on the same day if it is an outpatient procedure, but someone needs to drive them home.
What is a central line?
A central line or central venous catheter (CVC) is a thin, flexible tube that is placed in a large vein for diagnostic or treatment purposes. It is typically placed in the large veins of the neck, chest, arm, or groin to administer fluids or medications or withdraw blood for diagnostic purposes.
A central line is particularly helpful when access to the vein is needed for long-time kidney dialysis or treatment. It can be used to provide nutrition (parenteral nutrition) to patients who cannot be fed by mouth. This saves time and prevents repeated discomfort from frequent needle pricks.
Unlike standard intravenous routes, where a small catheter is used to administer medications into a vein near the skin’s surface for shorter periods of time, a central line uses a longer catheter that empties in or near the heart and can be left in place for weeks or months. A central line may be used in intensive care unit (ICU) settings, long-term care facilities, outpatient care (such as in dialysis centers), or for at-home care of patients with certain chronic or serious illnesses (such as cancer).
What are possible risks of central line placement?
Because central lines are placed in a large vein and for longer durations, they generally carry more risks than a standard intravenous (IV) line. The doctor decides whether to place the line depending on the benefits of placing the line in comparison with the associated risks.
Some of the risks of a central line include the following:
- Air embolism (blockage of an artery or a vein due to entry of one or more air bubbles)
- Pneumothorax (presence of air between the lungs and the chest wall)
- Arrhythmia (abnormal heart rhythm)
- Blood vessel injury
- Nerve injury
- Catheter misplacement or malposition
- Subcutaneous hematoma (collection of blood under the skin)
- Hemothorax (collection of blood in the space between the lung and chest wall)
- Cardiac arrest (in fewer than 1% of cases)
Health Solutions From Our Sponsors
Young MP, Yuo TH. Overview of complications of central venous catheters and their prevention in adults. UpToDate. https://www.uptodate.com/contents/overview-of-complications-of-central-venous-catheters-and-their-prevention-in-adults
Centers for Disease Control and Prevention. Frequently Asked Questions about Catheters. https://www.cdc.gov/hai/bsi/catheter_faqs.html
Johns Hopkins Medicine. Central Line Placement. https://www.hopkinsmedicine.org/interventional-radiology/procedures/clp/
Top Placing a Central Line With Ultrasound Guidance Related Articles
Healthy Eating: Foods That Help Increase Blood Flow CirculationGood blood flow circulation occurs when you eat the right foods. Choose cayenne pepper, beets, berries, fatty fish, pomegranate, garlic, walnuts, grapes, turmeric, spinach, and citrus fruit to keep blood flowing.
Is the External Jugular Vein a Central Line or a Peripheral Line?External jugular vein (EJV) may be used as a central line, although it is preferred as a peripheral line since the vein is close to the surface of the skin.
How Do You Give Intravenous Insulin Therapy?Intravenous insulin therapy is a treatment procedure to control high blood sugar (hyperglycemia) in ICU patients. Rapid and efficient control of hyperglycemia improves recovery rates and reduces mortality in critically ill patients. People with diabetes self-administer their daily doses into the skin, not into a blood vessel.
How Do You Insert an IV Cannula Successfully?Intravenous catheters (IV cannula) allow medical professionals to draw multiple blood samples or administer drugs, fluids, and nutrition to a patient.
Ibuprofen intravenous (IV)Ibuprofen intravenous (IV) is a non-steroidal anti-inflammatory drug (NSAID) administered into the vein (intravenous) to treat pain, fever, and patent ductus arteriosus (PDA) in newborn babies. Side effects of ibuprofen vary depending on the type of treatment, which can include nausea, vomiting, gas (flatulence), headache, low red blood cell count (anemia), presence of bacteria in blood (bacteremia), low protein levels in blood (hypoproteinemia), high blood pressure (hypertension), sepsis, bleeding in the brain, cessation of breathing (apnea), bacterial pneumonia, dizziness, and others.
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.
How Many Types of Cardiac Catheterization Are There?
What Is an Intravascular Ultrasound Used For?An intravascular ultrasound (IVUS) is an invasive imaging procedure that helps diagnose and treat conditions that affect the coronary arteries and other blood vessels.
What Is Intravenous Immunoglobulin Used For?Intravenous immunoglobulin (IVIG) therapy is a treatment for people with weakened immune systems. Intravenous immunoglobulins are antibodies prepared from pooled plasma of over 1,000 healthy blood donors. The pooled plasma samples are purified before administration.
What Is Intravenous Insulin Therapy?Intravenous insulin therapy is a treatment procedure to manage high blood sugar (hyperglycemia) with intravenous infusion of insulin. Intravenous insulin is administered only in a hospital ICU setting in selected critically ill patients with a diabetes emergency or other conditions affecting blood sugar. People with diabetes self administer insulin subcutaneously, not in the vein.
What Is Subclavian Central Venous Access?Central venous access is required in a variety of clinical scenarios with the subclavian veins serving as the favored site in most cases.
Which Cannula Is Used in Pediatrics?Cannulas in pediatrics are used to administer IV therapy and may range in size from 24- to 22-gauge depending on various factors. Learn more about cannulation in children.