Central line and arterial line insertion (Central venous catheter and arterial cannula insertion)
A plain-English guide for patients and families explaining the fine tubes placed into a vein and an artery in intensive care, used to give medicines, monitor blood pressure and take blood without repeated needles.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- A central line goes into a large vein to give medicines and fluids and to take blood; an arterial line goes into an artery to monitor blood pressure precisely.
- Both are placed through a small skin puncture with local anaesthetic, not by an operation, and leave no surgical scar.
- They spare the person repeated needles and let the team treat and monitor them very closely.
- The main risks are infection, bleeding or bruising, and — for neck or chest central lines — a small chance of a collapsed lung; lines are removed as soon as they are no longer needed.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your specialist will give you advice for your situation.
Allows several medicines and fluids to be given at once, including strong drugs
A particular site may be avoided if it is infected, injured, or has poor blood flow.
The line is secured and starts working. For a neck or chest central line, an X-ray usually checks it is in the right place before strong drugs are given...
Daily inspection of each line site for signs of infection.
The line is secured and starts working. For a neck or chest central line, an X-ray usually checks it is in the...
Nurses check the site for redness, swelling or leaking, keep the dressing clean, and use the line for medicines...
The line is gently slipped out at the bedside and pressure is applied. An arterial line site is pressed firmly for...
The small puncture closes quickly. There may be a little bruising, which fades over days; there is no surgical...
What are central lines and arterial lines?
When someone is seriously ill, the team often needs to give several medicines and fluids at once, take frequent blood samples, and watch the blood pressure very closely. Two special tubes make this possible without endless needles.
A central line is a fine, soft tube placed into a large vein — usually in the neck, upper chest or groin. It can carry several medicines and fluids at the same time, including strong drugs that would irritate small veins in the hand. It is also used to take blood and to measure pressures inside the body.
An arterial line is a smaller tube placed into an artery, often at the wrist. Because arteries carry blood under pressure, it gives an accurate, second-by-second blood pressure reading on the monitor and lets the team take blood samples easily.
These are not surgery and leave no surgical wound. Each is put in through a small puncture in the skin after careful cleaning, usually with local anaesthetic and using an ultrasound scanner to find the vessel. They are a normal, everyday part of intensive care, and are removed once they are no longer needed.
Types, options & approaches
There may be different ways to do this. The right approach depends on the clinical question and your circumstances.
Central line vs arterial line
| Feature | Central line | Arterial line |
|---|---|---|
| Goes into | A large vein | An artery |
| Mainly for | Giving drugs and fluids | Monitoring blood pressure |
| Usual site | Neck, chest or groin | Wrist |
| Blood samples | Yes | Yes |
Many intensive care patients have both at the same time; they do different jobs.
Preparing for your procedure
- In intensive care these lines are usually placed urgently, so there is little to prepare.
- If the person is awake, the team will explain what they are doing and why.
- Tell staff about bleeding problems, blood-thinning medicines, or past trouble with lines.
- Mention any allergies, including to chlorhexidine skin cleaner or local anaesthetic.
- The skin is cleaned carefully and sterile drapes are used to lower the risk of infection.
- An ultrasound scanner is often used to find the vessel and place the line safely.
What happens
The procedure is done at the bedside or in theatre. The skin over the chosen vein or artery is cleaned thoroughly and covered with sterile drapes. Local anaesthetic numbs the skin, though a very ill person is often already sedated.
Using an ultrasound scanner to see the vessel, the doctor makes a small puncture with a needle, then threads the soft tube into place over a fine guidewire. The tube is stitched or stuck securely to the skin and covered with a clear dressing so it can be watched. Placing each line usually takes about 15 to 30 minutes.
For a neck or chest central line, a chest X-ray is often taken afterwards to confirm the tube is in the right place and that the lung has not been affected. The lines connect to drips, pumps and the monitor, and start working straight away.
Is this procedure right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- A particular site may be avoided if it is infected, injured, or has poor blood flow.
- The neck or chest route may be avoided in people with serious bleeding problems, favouring a different site or approach.
- An arterial line may be avoided in a limb with poor circulation.
- The team chooses the safest site for each person rather than following a fixed rule.
Delay or rearrange if…
- In an emergency these lines are placed without delay, as they are often needed urgently.
- Where there is time, the team may correct severe bleeding problems first or choose a safer site.
- If a line is not yet needed, it is not placed — lines are only used while required.
- Concerns about infection at a site mean a different site is chosen rather than waiting.
Alternatives to discuss
- A standard small cannula (drip) in the hand or arm, for less ill patients or short-term use.
- A different insertion site if one area is unsuitable.
- Blood pressure measured with an arm cuff rather than an arterial line, where continuous monitoring is not needed.
- Removing a line and not replacing it once the person no longer needs that level of access.
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Comfort, sedation or contrast choices
If local anaesthetic, sedation, contrast or pain relief is used, ask what is planned, why, and what it means afterwards.
Benefits
- Allows several medicines and fluids to be given at once, including strong drugs
- Avoids repeated needles for blood tests and drips
- Gives an accurate, continuous blood pressure reading (arterial line)
- Lets the team measure pressures that help guide fluid and drug treatment
- Provides reliable access in an emergency when small veins are hard to use
- Can stay in place for as long as it is needed, then be removed
Risks & complications
- Some bruising, bleeding or soreness where the line goes in
- A small risk of the line becoming blocked over time
- Discomfort at the site, especially with the arterial line at the wrist
- The dressing needing changing to keep the area clean
- Infection at the skin site, or spreading into the blood from the line
- The line moving out of position and needing to be repositioned or replaced
- A blood clot forming in the vein around a central line
- Difficulty placing the line, sometimes needing more than one attempt
- A collapsed lung (pneumothorax) when a neck or chest central line is placed
- Damage to a nearby artery, nerve or other structure during insertion
- Reduced blood flow to the hand from an arterial line, very rarely affecting the fingers
- Air entering the line (air embolism), which is rare with careful technique
Infection that spreads from a line into the blood is the most important risk to prevent, which is why strict cleaning and regular checks matter. For neck and chest central lines there is a small chance of a collapsed lung, usually spotted on the X-ray. Ultrasound guidance has made these lines safer. Ask the team how the line is being kept clean and when it will be removed.
Published figures to discuss
How likely complications are depends on the site chosen, the person's anatomy and how ill they are. Ultrasound guidance has reduced problems such as accidental artery puncture and collapsed lung. Serious complications are uncommon, but because exact rates vary between settings and patients, the team will explain the risks for your relative rather than rely on a single figure.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Pneumothorax after central venous catheter insertion | Uncommon; risk is lower with ultrasound-guided internal jugular access and higher with subclavian access | Breathlessness, chest pain or falling oxygen levels after insertion need prompt assessment and often a chest X-ray or ultrasound. | NHS — Intensive carenhs.ukSource-linked context |
| Central-line bloodstream infection | Uncommon with modern sterile bundles, but risk rises with duration and emergency insertion | Daily review of whether the line is still needed is one of the most effective safety steps. | NHS — Intensive carenhs.ukSource-linked context |
| Bleeding, arterial puncture or haematoma | Uncommon, higher with coagulopathy, anticoagulants and difficult anatomy | Ultrasound guidance reduces but does not remove the risk of wrong-vessel puncture. | NHS — Intensive carenhs.ukSource-linked context |
| Arterial-line complications | Serious hand or limb ischaemia is rare | Cool, painful, pale or numb fingers after an arterial line need urgent review. | NHS — Intensive carenhs.ukSource-linked context |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
What happens afterwards
There is no separate recovery from having these lines placed — they are part of being looked after in hospital. Most people feel little from them once they are in, and they are removed at the bedside when no longer needed.
- A small puncture mark and perhaps some bruising where the line was
- Mild tenderness at the site that settles over a few days
- A clear dressing over the site while the line is in place
- Needing the line replaced if it has been in for a long time, to reduce infection risk
- No stitches to remove from the skin once any securing stitches are taken out
Aftercare
- Keep the dressing clean and dry while the line is in, and tell staff if it loosens.
- Tell the nurse straight away about redness, swelling, pain or leaking at the site.
- Do not pull or tug on the line or its connections.
- After an arterial line is removed, keep pressure on as advised to stop bleeding.
- Watch for fever or feeling unwell, which can signal a line infection.
- Report any numbness, coldness or colour change in the hand near an arterial line.
- Know which lines are in and what each is for
- Ask how long each line is expected to stay in
- Understand the signs of a line infection to watch for
- Keep the dressing dry and report if it comes loose
- Know who to tell if the site looks red, swollen or sore
- Ask when and how the line will be removed
⚠ Get urgent help if…
- Spreading redness, swelling, warmth or pus where the line goes in
- A high temperature, shivering or feeling generally very unwell
- Bleeding from the site that does not stop with pressure
- Sudden breathlessness or chest pain after a neck or chest line is placed
- Numbness, coldness, paleness or a blue tinge in the hand near an arterial line
- The line looking longer than before, leaking, or coming out
Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your specialist gives you.
Results & realistic expectations
When a line is working well, it lets the team give treatment and monitor the person reliably without repeated needles. A neck or chest central line is usually checked with an X-ray to confirm it sits correctly. The lines are removed as soon as they are no longer needed, which lowers the risk of infection.
These lines support care but do not treat the illness themselves. They cannot remove the small risks of infection, bleeding or, for central lines, a collapsed lung — though careful technique and ultrasound make these uncommon.
Lines are temporary. Arterial lines and central lines are kept only as long as they are needed and are often changed after a number of days to reduce infection risk. Once removed, the small puncture closes on its own and there is no lasting mark beyond, at most, a tiny dot and some short-lived bruising.
Related tests, treatments or support
These lines are placed as part of wider intensive care and rarely on their own. A central line is often inserted at the same time as starting strong medicines or kidney support, and an arterial line alongside it when continuous blood pressure monitoring is needed.
Follow-up & long-term care
While a line is in place, the team checks the site every day and decides daily whether it is still needed. After removal, the site is simply watched until the puncture has closed. Any sign of infection is followed up promptly.
- Daily checks of the line site for signs of infection
- Regular dressing changes using a clean technique
- Reviewing each day whether the line is still needed
- Changing a line after a set time, or sooner if there is concern
- Prompt removal once the line is no longer required
Repeat, follow-on and what comes next
- A line may need more than one attempt to place, which is common and not a sign of a problem.
- Lines are often changed after a set number of days to reduce infection risk.
- A line that moves, blocks or shows signs of infection is removed and, if still needed, replaced.
- Removing a line that is no longer needed is good practice, not a setback.
Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.
What good aftercare looks like
- Daily inspection of each line site for signs of infection.
- A clear plan for when each line will be removed.
- Prompt removal of any line that is no longer needed.
- Clean dressing changes and careful handling of connections.
- Quick action if there is any sign of infection, bleeding or a misplaced line.
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- These lines are placed as part of NHS intensive care, so families do not usually face a separate bill.
- Where any private critical care exists, the cost is part of the overall intensive care stay.
- Ultrasound guidance and sterile, single-use kit are part of safe insertion.
- An X-ray to check a neck or chest line adds to the care provided.
- The number and type of lines, and how long they stay in, affect overall resource use.
- Specialist staff time for insertion and daily line care is part of critical care.
- Confirmation that line insertion is part of the wider critical care, not a separate charge
- Who places and looks after the lines
- How infection is prevented and monitored
- What happens if a line needs replacing or causes a complication
- Whether an X-ray check is included for neck or chest lines
- How the family will be kept informed about the person's care
On the NHS? Placing central and arterial lines is a routine part of NHS intensive care and emergency treatment, not a separately bookable private procedure.
You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- The person or family not being told which lines are in and why.
- No mention of the small risk of a collapsed lung with neck or chest central lines.
- Lines being left in longer than needed, raising the risk of infection.
- Not explaining the signs of a line infection to watch for.
- Assuming a line is harmless and skipping checks of the site.
Marketing red flags
- Any service describing line insertion as completely without risks.
- Claims that a private setting can avoid line infections altogether.
- Downplaying the importance of an X-ray check for neck and chest lines.
- Pressure to keep lines in for convenience rather than clinical need.
Choosing a specialist safely
- Check the specialist is on the GMC Specialist Register for this area.
- Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
- You're entitled to time to consider and to have your questions answered before you agree — the specialist who looks after you should explain it, not a salesperson.
- Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including any follow-up — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good specialist will welcome every one of these.
- Which lines does my relative have, and what is each one for?
- How are you keeping the lines clean to prevent infection?
- How long do you expect the lines to stay in?
- Was the central line position checked, and is the lung fine?
- What signs of a problem should I tell the nurse about?
- When and how will the lines be removed?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the specialist who carries out my procedure, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this procedure not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Is putting in a line an operation?
Does it hurt?
Why does my relative need both a central line and an arterial line?
Why was a chest X-ray taken afterwards?
Will it leave a scar?
How long can the lines stay in?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: NHS — Intensive care Great Ormond Street Hospital — Central lines and arterial lines Faculty of Intensive Care Medicine — What is intensive care? ICUsteps — Intensive care: a guide for patients and relatives
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
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