What is a CVL?
A central venous line (CVL) is a special intravenous (IV) line. A CVL is a long, soft, thin, flexible tube that is inserted into a large vein. You might also hear a CVL called a central line or a central venous catheter.
Why is a CVL inserted into the internal jugular vein?
A CVL inserted into the internal jugular vein is used in children who need IV therapy for a long period of time. IV therapy can include medications, chemotherapy and IV fluids.
Regular IV lines are usually inserted into a vein in the hand, arm, foot or leg. A child who needs IV therapy for a long period of time would need to have a regular IV line inserted quite often. This can be painful and damaging to a child's veins.
Having a CVL inserted makes it easier and more comfortable for your child to receive IV therapies. If your child has a CVL inserted to receive IV therapy then it can also be used to take blood samples, for total parental nutrition (TPN), and for some treatments such as dialysis and stem cell collection.
Where can CVLs be inserted?
CVLs are inserted at femoral, subclavian and internal jugular sites. The internal jugular vein is the most common site used in children when the line will be in place for longer than seven to 14 days.
How are CVL’s inserted into the internal jugular vein?
The CVL is inserted using image guidance by an interventional radiologist, but it can also be inserted by a surgeon in the operating room or by an intensivist in an intensive care unit.
For CVLs that are inserted by an interventional radiologist, the tip of the catheter is inserted into a vein in the neck (internal jugular vein) with the assistance of ultrasound and a special X-ray called fluoroscopy. The catheter is guided through the veins until it is positioned in the large vein (superior vena cava) leading to the heart, where blood flow is fast. This placement allows for better mixing of medicines and IV fluids. The rest of the CVL is tunneled under the skin, from the neck to the chest area.
A chest X-ray may also be done after the procedure to check the placement of the CVL.
Risks of a CVL insertion
A CVL insertion is usually a low-risk procedure. The risk may increase depending on your child’s condition, age and health.
The risks of any CVL insertion can include:
- failure to find an open vein that will accept the CVL
- bleeding or bruising
- pain or discomfort
- infection
- clotting
- air in the lungs or veins
- irregular heart rhythm
- breakage of the catheter
- movement of the catheter
- X-ray exposure
- vein perforation
- nerve or artery damage
Preparing for a CVL insertion
If your child is already in the hospital, you will meet a nurse from the Vascular Access Service who will explain the procedure and answer your questions. If your child is an outpatient, the health-care team looking after your child will explain the procedure to you.
Giving consent before the procedure
Before the procedure, the interventional radiologist or nurse practitioner will go over how and why the procedure is done, as well as the potential benefits and risks. They will also discuss what will be done to reduce these risks and will help you weigh the benefits against them. It is important that you understand all of these potential risks and benefits of the CVL insertion and that all of your questions are answered. If you agree to the procedure, you can give consent for treatment by signing the consent form. A parent or legal guardian must sign the consent form for young children. The procedure will not be done unless you give your consent.
How to prepare your child for the procedure
Before any treatment, it is important to talk to your child about what will happen. When talking to your child, use words they can understand. Let your child know that medicines will be given to them to make them feel comfortable during the procedure.
Children feel less anxious and scared when they know what to expect. Children also feel less worried when they see their parents are calm and supportive.
Food, drink, and medicines before the procedure
- Your child’s stomach must be empty prior and during sedation or general anaesthetic.
- If your child has special needs during fasting, talk to your doctor to make a plan.
- Your child can take their regular morning medicine with a sip of water two hours before the procedure.
Medicines such as acetylsalicylic acid (ASA), naproxen or ibuprofen, warfarin, or enoxaparin may increase the risk of bleeding. Do not give these to your child before the procedure unless they have been cleared first by your child’s doctor and the interventional radiologist.
On the day of CVL insertion into the internal jugular vein
Your child will have medicine for pain
It is important that your child is as comfortable as possible for the procedure. Your child will receive a general anaesthetic for the CVL insertion, so they will not hear or feel anything during the procedure.
During the procedure, you will be asked to wait in the waiting area.
After CVL insertion into the internal jugular vein
Once the CVL insertion is complete, your child will be moved to the recovery area. The interventional radiologist will come and talk to you about the details of the procedure. As soon as your child starts to wake up, a nurse will come and get you.
The CVL can be used right away for your child's medication or fluids. Your child should not feel any pain when the CVL is being used.
How long can the internal jugular vein CVL stay in?
A CVL can stay in for months or years, as long as it remains problem-free and working well.
Removing the internal jugular vein CVL
Once your child's health-care team is confident that the CVL is no longer needed, they will make arrangements for the CVL to be removed. CVLs are removed under sedation or general anaesthesia. This procedure typically takes 30 minutes. Eating and drinking restrictions on the day of the procedure are similar to when the CVL was inserted.
At SickKids
At SickKids, the interventional radiologists work in the Department of Diagnostic Imaging – Division of Image Guided Therapy (IGT). You can call and speak to the Vascular Access Service resource nurse at (416) 813-6986 during working hours, or leave a message with the Vascular Access Team. If you have concerns and it is after working hours, please call The Hospital for Sick Children switchboard at 416-813-7500 and ask them to page your child’s doctor on call, or go to the nearest Emergency Department.
For more information on fasting, see “Eating and drinking before surgery.”
For more information on preparing your child for their procedure, see “Coming for surgery.”