Inserting and Removing Central Lines: What to Expect

Central lines are IVs that can be inserted through the skin. These lines have a thin, long hollow tubing or catheter. This catheter is threaded through your smaller veins and into your larger central veins, such as the superior vena cava.

Central lines can stay in place for months to years depending on the type. They can be used to draw blood or administer fluids, antibiotics, parenteral nutrition or other medications. Although they provide a safe and effective way to access your veins, there are slight risks. In some cases, a central line may cause infection, become blocked, or develop a blood clot.

Central Venous Catheters: PICC Lines versus Ports

A central line may be beneficial in any of the following situations:

• Your veins are small, hidden, or damaged, which can make it hard for a nurse to find a vein to draw blood from or insert an IV.
• You need to receive treatment for more than one day at a time or over an extended period.
• You require more than one medication at a time.
• You wish to be treated at home, or you require a continuous infusion.
• You need what are called “vesicant drugs,” which may damage your skin tissue if they leak outside of your veins.

There are a few types of central lines commonly used for chemotherapy treatments. The type your doctor recommends depends on the length and type of your treatment. Your personal preference is also taken into consideration, as they all have different pros and cons. The three most commonly used include:

Peripherally Inserted Central Catheter (PICC)

A peripherally inserted central catheter, or PICC line, is inserted in a large vein in your arm near your elbow. This is usually done using local anesthesia by a specially trained nurse. One end of the catheter will remain outside of your skin. A special dressing will cover the PICC when it’s not in use. The line requires a weekly dressing change to prevent infection. The line will also need to be kept dry at all times, so it should be covered during bathing or showering.

Implantable Chest Port

A surgeon can insert an implantable chest port under your skin about an inch below the center of your collarbone. This process usually requires conscious sedation. You’ll be able to see and feel the port under your skin, but it doesn’t require any bandage or dressing.

Tunneled Catheter

A specialized doctor or nurse can insert a tunneled catheter into your neck vein or chest. They’ll pass one end under the skin before it exits though a small incision in your skin. Like a PICC line, part of the catheter will remain outside of your skin. This process requires local anesthesia or conscious sedation.

Because central lines can get infected, it’s important that you call your doctor right away if you notice any signs of infection. These can include:

• redness
• streaking
• swelling
• pain
• a fever
• drainage
• bleeding
• a warm sensation
• a burning sensation

The removal process depends on the type of line you have.

PICC Removal

PICC lines don’t need to be removed in an operating room. A doctor or nurse can remove them immediately after your last infusion. After cleansing the area, they’ll gently pull the catheter until it’s removed. They’ll apply slight pressure to stop any bleeding and cover the area with sterile gauze dressing. The dressing should stay on for 24 hours. You should avoid heavy lifting or strenuous activity during this 24-hour period.

Though the PICC line removal process seems simple, it should only be done by a doctor or trained nurse. Never remove a PICC line yourself.

Implanted ports are removed using local anesthesia or conscious sedation. This is done in a sterile, operating room setting. During the procedure, a small incision is made and the port and catheter are removed. The wound will usually be closed using Steri-Strips.

It’s important to avoid getting your incision wet until your doctor gives the okay.

It’s normal to experience bruising, swelling, and tenderness for several days over the area the port was removed. This should improve in a few days and may be relieved with Tylenol and Advil if your doctor approves.

Call your doctor if:

• you have pain, bruising, or swelling that worsens instead of improves
• pus or fluid seeps from your incision
• the removal area becomes hot, red, and irritated
• you develop a fever
• there’s a lot of bleeding from your incision

Having a central line can reduce some of the pain and anxiety caused by regular blood draws and IV infusions. They do have some pros and cons, which vary depending on the type of line you have. If you’re going to have chemotherapy or other IV cancer treatments, be sure to talk with your doctor about which type of central line is best for you. Your doctor can address questions or concerns you may have about the insertion or removal process.