What are the risks and benefits of getting a central line?

Central Line Risks and Benefits: Patient Explanation

A central line provides reliable access for medications and nutrition that cannot be given through regular IVs, but carries approximately a 3% risk of major complications during placement and ongoing risks of infection (about 5 per 1000 days) and blood clots (about 3 per 1000 days). 1

Benefits of Central Lines

Reliable venous access for essential therapies:

• Allows delivery of medications, nutrition solutions, and blood products that are too concentrated or irritating for peripheral veins 2
• Provides direct access to large central veins (superior vena cava or right atrium) where high-flow blood rapidly dilutes infused solutions 2
• Can remain in place for extended periods—tunneled catheters may stay functional for many years 2
• Eliminates repeated needle sticks for patients requiring long-term intravenous therapy 2

Specific clinical advantages:

• Essential for parenteral nutrition when the gastrointestinal tract cannot be used 2
• Allows administration of chemotherapy, long-term antibiotics, and other critical medications 3, 4
• Provides reliable access for blood transfusions and blood sampling 3

Risks of Central Lines

Placement Complications (Immediate Risks)

Mechanical complications during insertion:

• Placement failure occurs in approximately 20 per 1000 attempts 1
• Arterial puncture (accidental needle stick into artery): 16 per 1000 placements 1
• Arterial cannulation (catheter mistakenly placed in artery): 3 per 1000 placements 1
• Pneumothorax (collapsed lung): 4-5 per 1000 placements 1
• Bleeding requiring intervention, nerve injury, or cardiac complications are possible but rare 2, 1

Important caveat: Using ultrasound guidance during placement significantly reduces these risks—arterial puncture drops from 69 to 14 events per 1000 catheters, and pneumothorax drops from 10 to 2 events per 1000 catheters 1

Use Complications (Ongoing Risks)

Catheter-related bloodstream infection:

• Occurs at approximately 5 per 1000 catheter-days 1
• Represents one of the most serious complications, though preventable with proper care 2
• Risk reduced through proper hand hygiene, chlorhexidine antiseptic use, appropriate dressing changes, and prompt removal when no longer needed 2

Thrombosis (blood clots):

• Deep vein thrombosis occurs at approximately 3 per 1000 catheter-days 1
• Can cause arm swelling, pain, and discoloration 5
• Femoral vein access carries 10 times higher thrombosis risk than subclavian access 2

Catheter malfunction:

• Occurs at approximately 6 per 1000 catheter-days 1
• Includes occlusion (blockage), dislodgement, or mechanical failure 2, 6
• Often manageable without catheter removal through flushing protocols or repair 2

Composite Risk Assessment

For a patient with a central line for 3 days, approximately 30 per 1000 patients (3%) will experience at least one serious complication (arterial cannulation, pneumothorax, infection, or blood clot). 1

Type-Specific Considerations

Short-term non-tunneled catheters (typical hospital use):

• Designed for continuous use over days to weeks 2
• Higher rates of infection, obstruction, and dislodgement compared to tunneled devices 2
• Should be removed as soon as no longer necessary to minimize complications 2

PICC lines (peripherally inserted central catheters):

• Lower insertion complication rates but higher thrombophlebitis risk compared to subclavian catheters 6
• Complication-free delivery rate of 46% versus 67% for subclavian catheters 6
• May be more difficult to insert in patients with damaged peripheral veins 2

Tunneled catheters (for long-term use):

• Can remain in place for years with proper care 2
• Lower infection rates than non-tunneled catheters 2
• Require external dressing and may affect body image 2

Totally implantable ports:

• Practically invisible under skin, no external dressing needed 2
• Require skin puncture for each use 2
• More difficult to salvage with antibiotics if infected—usually require removal 2

Common Pitfalls to Avoid

Site selection matters significantly:

• Femoral vein access is relatively contraindicated due to high contamination and thrombosis risk 2
• Subclavian approach associated with lower infection rates than jugular insertion 2
• High jugular approaches create difficult-to-maintain exit sites with higher infection risk 2

Prevention strategies are critical:

• Ultrasound guidance should be used for all central line insertions 2, 1
• Maximal barrier precautions during insertion reduce infection risk 2
• Chlorhexidine antiseptic superior to other options for skin preparation 2
• Multi-lumen catheters increase infection risk—use single-lumen when possible 2

Monitoring requirements:

• Catheter tip position must be verified (ideally during procedure, mandatory post-procedure X-ray) 2
• Regular assessment for signs of infection (redness, drainage, fever) 5
• Vigilance for thrombosis symptoms (arm swelling, pain) 5
• Proper flushing and locking protocols when catheter not in use 2, 3