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Central Lines

A central line is a catheter inserted into a central vein for the purpose of drug delivery, blood sampling, haemodynamic measurement and renal filtration.

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Types of central access include:

  • CVC

    • Internal jugular vein​

    • Subclavian vein

    • Femoral Vein

  • Peripherally inserted central catheter (PICC)

  • Vascath

    • Similar positioning to CVC​

    • Utilised for renal replacement therapy

      • May be used as central access device if required

        • Usually 'Hep-locked'​ - small volume (1.5ml) of heparin left in catheter to prevent clotting between use

        • Must be aspirated prior to use

Confirming Central Line Position on CXR

  • What type of central line?

    • Internal jugular vs subclavian vs PICC​

    • Femoral lines do not need confirmation on CXR

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  • Where is the central line?

    • Right sided – NEVER crosses the midline/mediastinum

    • Left sided – ALWAYS crosses the midline/mediastinum

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  • Tip Position

    • Tip ideally sits around the level of the carina (+/- 1 cm)

    • Tip not greater than ~1.5cm above carina

      • Do NOT push in further (this is never done once line is secured and operator has un-scrubbed) - external component is no longer sterile

      • Can often still be used even if tip is sitting too distal; check with ICU registrar/consultant prior to use

    • Too far in?

      • If tip is more than 1-2cm distal to carina or it curves, it may be too far in

      • Check with ICU registrar/consultant - it may need to be withdrawn a few centimetres prior to use​

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  • Check for complications

    • Pneumothorax / Pneumomediastinum

      • Highest risk with subclavian insertion​

    • Kinked or line looped around itself

    • Subcutaneous emphysema

    • Retained guidewire

      • SHOULD NOT REQUIRE A CHEST XRAY

Images from radiologymasterclass.co.uk

       Author: Dr. Kirsty O'Keefe, Peer Reviewer: Dr. Irma Bilgrami Date: 22/03/20

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