Central Venous Line Insertion

A central venous line (CVL) catheter is placed into a centrally located vein — typically in your child’s neck, chest, or groin — so doctors can give her fluids, nutrients, or medication over a long period of time. The Division of Interventional Radiology uses ultrasound and a special type of x-ray technology, called fluoroscopy, to guide the placement of the catheter.

When might a CVL be needed?

Central venous lines are most often used to provide long-term intravenous care. Sometimes, they are used in very ill children who need secure intravenous access or in patients in whom other attempts at obtaining intravenous access have failed.

Is central venous line insertion painful?

The procedure is performed with anesthesia or sedation, so your child will experience minimal pain during the procedure. Your child may feel some discomfort at the catheter entry site for a few days after the procedure.

How should I prepare my child for CVL insertion?

Explain to your child in simple terms why the procedure is needed and what will happen.

• Assure your child that you will be close by during the procedure.
• Your child may bring a favorite toy or blanket into the room.

What will happen before the procedure?

A nurse will talk to you in advance about when your child should stop eating, drinking, and taking medications.

Your child may need to visit the preoperative clinic, where she will meet with a nurse and an anesthesiologist, and undergo any necessary laboratory tests. You and your child will then meet with the nurse practitioner in the Division of Interventional Radiology. Please plan on spending between two to four hours at the hospital for the preoperative visit.

The day of the procedure:

• The interventional radiologist will talk to you about the CVL insertion and ask you to sign the consent form. (You must be your child’s legal guardian to sign this form. If you are a legal guardian and not a parent, you must bring the paperwork showing proof of legal guardianship.)
• Your child will change into a hospital gown.
• A nurse or anesthesiologist may start an intravenous (IV) line.
• Once your child is asleep, you will be escorted to a special waiting area.
• If your child is having a local anesthetic the scheduling office will tell you where and when to report for the procedure.

What will happen during central venous line insertion?

• Before the procedure is started, your child is given medication for relaxation (a sedative) or general anesthesia.
• The area in which the catheter will be inserted is cleaned with a special liquid that helps prevent infection and carefully covered with drapes.
• Local anesthetic is injected into the skin to numb the area.
• After localizing the vein to be catheterized with ultrasound or x-ray guidance, the interventional radiologist inserts a needle through the skin into the vein.
• A guide wire is passed through the needle and used to direct a catheter of appropriate length to the right location.
• Alternatively, some catheters are "tunneled" under the skin. This means that before passing the catheter into the vein, a segment of the catheter is passed through a small track under the skin. This technique is useful for longer-term catheters, as it decreases the chance of dislodgement and infection.
• The catheter is then secured and a bandage is applied.

What happens after the procedure?

• Your child will be taken to the Interventional Radiology Post-Anesthesia Care Unit (PACU). You will be allowed to come to the recovery area to be with your child.
• The nurse will monitor your child closely until it’s time to be admitted or return to the hospital room.
• The interventional radiologist will speak to you about the procedure.

Is central venous line insertion safe?

When performed by a trained and experienced interventional radiologist, CVL placement is safe. However, as with all invasive procedures, complications and side effects may occur. These will be explained to you in detail before you give your consent.

Your child will be exposed to ionizing radiation (x-rays) during this procedure. While we always attempt to minimize exposure to x-rays, we believe that the benefit of treatment outweighs the exposure that occurs during the exam.

Because children are more sensitive to radiation exposure than adults, we have been leaders in adjusting equipment and procedures to deliver the lowest possible dose to young patients.

How Boston Children’s Hospital approaches CVL insertion

This procedure is performed by interventional radiologists who are highly trained in placing these catheters in infants and children.

In addition to the interventional radiologist, your child will be treated by a team of anesthesiologists, nurse practitioners, nurses, and technologists who specialize in caring for children undergoing interventional radiology procedures and treatments.

We perform CVL insertions in the interventional radiology suite on the second floor of the hospital, which features three procedure rooms equipped with the latest imaging technology, a recovery area for patients who have received sedation or anesthesia, and examining rooms for outpatient visits.