A central line (central venous catheter) is a long, thin tube (catheter) that provides long-term venous (vein) access. It is placed into a large vein that ends close to the heart. Types of central lines include peripherally inserted central catheter (PICC), tunneled central line, and subcutaneous port. A central line can be used to give your child medicines, fluids, or nutrition or to take blood samples.
Central lines are important for medical care and quality of life, but problems can happen. Possible central line complications include:
Problems after the procedure to place the central line
Swelling and irritation of the vein
Infection (CLABSI)
Blockage, damage, or movement of the central line
Blood clots
Your care team will talk with you about these risks and how to prevent them. They will treat problems if they happen.
Report any problems right away to prevent complications from getting worse. Ask your care team if you have questions.
If your child has a central line, follow all care instructions and talk to your care team about what problems to watch for.
Risks of the central line placement procedure
A central line is placed through a procedure to make an opening in the skin and into a vein. The catheter is guided through the vein until it reaches a spot near the heart.
It is rare for children to have problems after central venous line placement surgery. But anesthesia and surgery have risks. These may include:
Contact your care team if you notice any signs of problems after central line placement.
Central line–associated bloodstream infection (CLABSI)
Children who have a central line are at risk for central line-associated bloodstream infection (CLABSI). This infection can happen when germs enter your child’s blood. Central line infections in children with serious illness are usually caused by bacteria. Less commonly, CLABSI may be caused by yeast or fungi.
Signs and symptoms of infection
Watch your child carefully for signs of infection, such as:
Fever, oral temperature of 100.4 °F (38 °C) or higher, or follow fever guidelines as directed by your care team
Pain, redness, swelling, soreness, or warmth where the line comes out of the body
Drainage, leaking fluid, or a foul smell where the line comes out of the body
Chills or body aches
Rapid heartbeat or fast breathing
Fatigue, fussiness, or confusion
Ways to prevent central line infection
It is important to follow your care team’s instructions for central line care and infection prevention.
Take good care of the central line. Keep the site clean and dry.
Avoid touching the central line when possible, and do not let anyone who is not trained touch the central line.
Clean your hands before and after doing any line care. Wash your hands with soap and water or use an alcohol-based hand sanitizer.
Make sure your child cleans their skin daily. Remember to keep the dressing dry. If your child cannot bathe or shower, use bath wipes as part of the daily cleaning routine as instructed.
Change your child's clothes twice daily – once in the morning and once in the evening (wake-up and bedtime). Change clothes if they become soiled.
Change bedding weekly, or right away if it gets dirty. Avoid reusing towels and washcloths.
Keep your home clean to reduce the spread of germs.
A central line may become blocked by medicine, blood products, or a kink in the line. There might be a blockage in the line if it is hard to flush with a syringe. If it seems hard to flush, do not force it. Stop and contact your care team.
Check the line for kinks that might stop liquids from going in.
Make sure the line is unclamped.
If your child’s line has a pump attached, make sure it is working.
If the block is from a blood clot, your care team might give your child medicine to clear the blockage.
Contact your care team if you notice any signs of blockage or difficulty flushing the line.
Central line damage and movement
Keep the central line secure, and do not tug or pull on it. If your child has a subcutaneous port (a central line that is completely under the skin), do not put pressure on it.
The line may have moved if:
It seems blocked.
The nurse cannot get a blood sample from it.
It causes pain or discomfort in your child's arm, shoulder, jaw, chest, or head when medicines or fluids go in.
The part of the tube that is outside of the body looks longer or shorter than usual.
If you think that your child’s line has moved, call your child’s care team.
Your care team will give you an emergency kit and teach you what to do in case the central line is damaged or comes out. The kit will include supplies like tape, a clamp, gloves, and gauze. Keep this kit with you at all times.
If you see a crack, a hole, or a cut in the line:
Clamp the line above the hole.
Clean the damaged area with an alcohol pad.
Wrap the area with sterile gauze.
Use tape to hold the gauze in place.
Call your clinic.
If your child has a tunneled central line that comes out:
If possible, have your child lie flat on their back.
Find the place where the line comes out of your child’s body (arm, leg, chest, or other part of the body). Put pressure on it for 5 minutes using gauze.
Cover the place where the line comes out of your child’s body (exit site) with gauze.
Use tape to hold the gauze in place.
Call your clinic.
Do not throw the line away. Save it and bring it with you to the hospital.
Blood clots
Blood clots stop blood flow to a part of the body. The symptoms of a blood clot can vary depending on where the clot is.
Contact your child’s care team if you notice:
Shortness of breath
Pain, swelling, or redness near the line areas, such as in the neck, shoulder, arm, or chest
Your care team will show you how to take care of your child's central line. You will practice with the team while your child is in the hospital. It is normal to feel nervous. With practice, line care will become more routine.
Only trained people should do line care. Carefully follow the care steps exactly as the care team taught you so that you do not spread germs.
Always wash your hands or use hand sanitizer before doing any line care. Wear disposable gloves for line care if advised by your care team.
Use clean supplies. Do not use supplies that have fallen on the ground.
Keep the central line dressing clean, dry, and secure. If the dressing gets loose, wet, or dirty, call your care team so that it can be changed right away.
Follow your care team’s instructions on how to keep the dressing dry when bathing.
Keep the line secure so it does not move. Do not tug or pull on the line. Be careful when taking off clothing.
Protect the dressing and tubing from germs. Do not let the tube from the line hang in the diaper area. If your child may drool or vomit, protect the dressing with a bib or other covering. Contact your care team if the dressing becomes wet or soiled so it can be changed right away.
Do not use scissors, hemostats, or other sharp objects near the line or tubing.
If the line is hard to flush, do not force it. Notify your care team immediately.
When to call your care team
Watch your child carefully for signs of central line problems. Contact your care team right away if you notice any of the following:
Fever or chills
Redness, swelling, tenderness, warmth, or bad smell around the central line site
Pus, bleeding, discharge, or leaking from the line
Trouble accessing or flushing the central line
Movement of the line or damage to the tubing
Questions to ask your care team
What problems might happen with my child’s central line?
What signs should I watch for?
How can I keep my child’s central line clean and safe?
What do I do if there is a blockage, damage to the line, or if the line moves or comes out?
How often will you check my child’s central line for problems?
What activities should my child avoid with a central line?
How can my child bathe with a central line?
How long will my child need to have the central line?
When should I call the care team or go to the emergency room?
Who should I call after hours or in an emergency?
Key points about central line problems
Your child may need a central line for treatment. It is a long-term IV to give medicines, fluids, or take blood.
Infection is the most common risk and can lead to a life-threatening condition called central line-associated bloodstream infection, or CLABSI.
Watch for signs of central line infection, blockage, damage, movement, or blood clots.
Follow your care team’s instructions for central line care and take steps to prevent infection.
Report any problems with your child’s central line to your care team right away.
A fever is an increase in body temperature that is often caused by an infection. Learn what to do if your child has a fever or other signs of infection.
