Informed Consent for Central Venous Catheter (Central Line) Insertion
Patient and Provider Information
What is a Central Line?
A central venous catheter, commonly known as a central line, is a thin, flexible tube placed in a large vein that leads directly to the heart. It is different from a standard intravenous (IV) line, which is placed in a small vein in the arm. A central line is required to: (1) deliver large volumes of fluids, blood, or medications quickly during critical illness; (2) safely administer irritating medications (such as chemotherapy, strong heart drugs, or intravenous nutrition) that can damage smaller arm veins; (3) allow continuous monitoring of blood pressure within the large veins; or (4) provide a way to draw blood samples without multiple needle sticks.
How is the Procedure Performed?
The central line is inserted under sterile conditions to prevent infection. The clinician will: (1) Position you flat or slightly tilted (with your head lower than your feet) to fill the veins. (2) Clean your skin with a strong antiseptic and cover your body with sterile drapes. The clinician will wear a sterile gown, mask, and gloves. (3) Use an ultrasound machine to locate the vein in your neck, chest, or groin. (4) Numb the skin with a local anesthetic injection, which may cause a brief stinging sensation. (5) Insert a needle into the vein, thread a guide wire through the needle, slide the flexible catheter over the wire, and then remove the wire. (6) Secure the catheter to your skin with sutures (stitches) or a securement device, and cover the area with a clear sterile bandage. (7) Confirm the position of chest lines with a quick X-ray before using the line. The procedure takes about 20 to 45 minutes.
Expected Benefits
Stable, long-lasting access to your bloodstream that does not fail or slip out easily. Elimination of frequent, painful needle pokes for blood draws and medication administration. Ability to receive life-saving medications and concentrated nutrition that cannot be safely given through standard arm IVs. Risks and Potential Complications
Bleeding and Bruising: Minor bleeding around the insertion site is common. If a blood vessel is accidentally punctured, more significant bleeding or a collection of blood under the skin (hematoma) can occur. Infection: Central lines lead directly toward the heart, making catheter-associated bloodstream infections (CLABSI) a serious risk. We use strict sterile techniques during insertion and daily care to minimize this risk. Collapsed Lung (Pneumothorax): When placing a line in the chest or neck, the needle passes close to the lung. In less than 1% of cases, the needle may puncture the lung, causing air to leak into the chest cavity. This can cause the lung to collapse, which may require placing a temporary tube in your chest to release the air and expand the lung. Heart Rhythm Irritation: During insertion, the guide wire or catheter may briefly touch the inside of the heart, causing temporary irregular heartbeats. These are monitored on a screen and resolve immediately when the line is adjusted. Blood Clots: A blood clot can form around the catheter or in the vein. This can block blood flow, causing swelling in your neck or arm, or the clot could break off and travel to your lungs (pulmonary embolism). Air Embolism: Air can accidentally enter the bloodstream through the catheter. This is a rare but serious emergency that we prevent by keeping the catheter clamped and positioning you correctly. Alternatives to a Central Line
Standard Peripheral IV: Placed in a hand or arm vein. These must be replaced every few days, frequently fail, and cannot handle irritating medications. PICC Line (Peripherally Inserted Central Catheter): A longer catheter inserted into an arm vein and threaded to a large vein near the heart. Placed by specialized nurses, but may not be feasible in emergency situations. Midline Catheter: A longer arm IV that does not reach the large central veins near the heart. Cannot be used for highly concentrated nutrition or irritating medications. Patient Acknowledgment and Authorization
I confirm that I have read this form or had it explained to me. I understand the clinical need for a central line, how the procedure is performed, the benefits, and the risks (especially infection and collapsed lung). I have had the opportunity to ask questions, and all my questions have been answered. I voluntarily authorize the clinician to perform this procedure.
Signatures and Verification
Patient Signature (or Legally Authorized Representative) Relationship to Patient (if Representative) Performing Clinician Signature Witness Signature (Optional)