 Central Venous Line Insertion
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Central venous line (CVL) insertion is a procedure that involves placement of a soft infusion catheter into a centrally located vein using vascular interventional techniques.
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CVL placement in the Radiology Department at Children's Hospital Boston is performed with image guidance. That means that ultrasound or x-ray imaging can be used to facilitate precise placement, both at the initial time of placing the needle into the vein and at the end of the procedure when the placement of the tip of the catheter near the heart is completed. In addition to the advantages of image guidance and the expertise of trained interventional radiologists, Children's Hospital Boston has highly trained and experienced anesthesiologists, radiology technologists and nurses to care for the patient during and after the procedure.
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The physician caring for you or your child will determine when a CVL is indicated. Usually CVL is placed in patients who need medium or long-term intravenous access, usually for infusion of fluids or drugs.
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When performed by an appropriately trained and experienced interventional radiologist, CVL placement is safe. However, all invasive procedures have related complications and side effects. These will be explained in detail to you before you give your consent for the procedure. The procedure will be carried out with anesthesia or sedation, so there will be minimal pain during the procedure. The patient may feel some discomfort at the catheter entry site for a few days after the procedure.
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You will be given instructions in advance of the procedure, but in general the patient is asked to stop eating solid foods eight hours prior to the procedure and to stop drinking clear fluids three hours before the procedure.
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Before a procedure is started, the patient is given medication for relaxation (sedative) or general anesthesia. The area in which the catheter will be inserted is cleaned with an iodine solution and carefully covered with drapes to prevent infection. 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. The catheter is then secured and a dressing (bandage) is applied. 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 catheters which are needed for longer term use, as it decreases the chance of dislodgement and infection. Once the dressing is in place, the patient is awakened and taken to the Recovery Room for observation. The catheter can be used immediately.
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Using ultrasound or x-ray guidance, the radiologist can precisely see the vein to be catheterized and can also see the needle as it approaches the vein. This ability to see the vein and needle simultaneously increases the precision of the procedure and avoids unnecessary passage of the needle into the nearby artery or lung tissue. The ability to monitor the catheter as it passes through the vein and to precisely see the final position of the catheter tip also permits more accurate placement of the catheter than when the catheter is placed without image guidance.
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As soon as the procedure is completed, the interventional radiologist will inform you of the results.
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To obtain additional information before or after the central venous line insertion, contact Children's Interventional Radiology Office at 617-355-6579. An appropriate person will be asked to return your call.
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