Where are central lines typically placed? A detailed guide to insertion sites

October 2, 2025 •

4 min read

Central venous catheters, or central lines, are inserted into nearly 5 million patients annually in the United States alone. They are vital tools for delivering medication and fluids, and understanding where are central lines typically placed? is crucial for patients and families.

Quick Summary

Central lines are typically placed in a patient's neck, chest, or groin, with the choice of site depending on a patient's clinical needs, health status, and the intended duration of treatment. These catheters are threaded into large veins, guiding their tip toward the heart for reliable access.

Key Points

Common Sites: Central lines are most often placed in the neck (internal jugular vein), upper chest (subclavian vein), or groin (femoral vein).
Specialized Lines: PICC lines are inserted in the arm, while tunneled catheters and implanted ports are surgically placed under the skin, often in the chest.
Duration of Use: The insertion site and type of central line depend on how long the patient will need the device, ranging from days (femoral) to years (ports).
Risk vs. Benefit: Each site has a unique risk profile; for example, the femoral site is high-risk for infection and is usually temporary, while the subclavian is often preferred for long-term use.
Ultrasound Guidance: Many central line placements, particularly in the neck, are performed with ultrasound guidance to increase safety and precision.
Patient Mobility: The placement site can affect patient comfort and mobility; ports and PICC lines allow for greater freedom of movement compared to femoral lines.

Understanding central venous access

Central venous catheters (CVCs), commonly known as central lines, are specialized intravenous (IV) catheters that are significantly longer and wider than standard peripheral IVs. While a regular IV is inserted into a small, superficial vein in the hand or arm for short-term use, a central line is placed into a large, central vein to allow for reliable, long-term access to the bloodstream. This is necessary for administering medications that are too harsh for smaller veins, for long-term chemotherapy or antibiotics, for delivering nutritional support, and for frequent blood draws or monitoring of blood pressure within the large veins near the heart.

The primary central line placement sites

Healthcare providers have several options for placing a central line, with the decision based on factors such as the patient's condition, the urgency of placement, and the duration the line will be needed. The most common insertion sites all lead into the body's largest veins, ultimately positioning the catheter's tip in or near the superior vena cava (SVC), the large vein that empties deoxygenated blood into the right side of the heart.

Internal jugular (IJ) vein

Located in the neck, the internal jugular vein is one of the most frequently used sites for central line placement, especially in critical care settings. It offers a direct and reliable path to the SVC, and its use is associated with a lower risk of certain complications compared to other sites. Clinicians often use ultrasound guidance to ensure accurate and safe placement by visually distinguishing the vein from the nearby carotid artery. Patients often prefer this site over a groin insertion, as it allows for more mobility.

Subclavian vein

Situated just beneath the collarbone (clavicle), the subclavian vein is another common access point. Its main advantage is a lower risk of infection and thrombotic complications compared to the femoral site. The procedure, however, carries a slightly higher risk of pneumothorax (collapsed lung) because the vein is near the top of the lung. The subclavian approach is often chosen for patients requiring a central line for several weeks or months, such as for long-term antibiotic therapy or home infusions, as it can be easily secured and dressed to prevent accidental dislodgement.

Femoral vein

Access via the common femoral vein, located in the groin, is typically reserved for emergency situations or when other sites are inaccessible. The primary advantage is ease of access, particularly when a patient is in a state of shock or requires rapid fluid administration. However, this site is associated with a higher risk of infection and blood clots due to its location, so the line is generally removed as soon as clinically appropriate. It is also less desirable for ambulatory patients, as it can be uncomfortable and limits mobility.

Specialized central line types and placement

Beyond the main, temporary access sites, there are central lines designed for specific durations and patient needs. These often require different insertion techniques.

Peripherally inserted central catheter (PICC) line

A PICC line is a central line that is inserted into a peripheral vein, usually in the upper arm (basilic or cephalic vein), and threaded until its tip rests in the superior vena cava. PICC lines are ideal for intermediate-term use, lasting from several weeks to a few months. This type of line offers a good balance of accessibility and lower risk of infection compared to some short-term options, and it is commonly used for patients who are not critically ill but require frequent or prolonged IV therapy.

Tunneled catheters and implanted ports

For patients who need central venous access for long periods, such as for ongoing chemotherapy or dialysis, tunneled catheters or implanted ports are used. A tunneled catheter is surgically inserted, with part of the catheter running under the skin of the chest before entering a central vein. This tunneling provides an extra layer of protection against infection. An implanted port is similar but is completely buried under the skin, with a small reservoir that is accessed with a needle. This option offers maximum convenience for active patients and has the lowest risk of infection among long-term devices.

Comparison of central line types and placement sites


Feature	Internal Jugular (IJ)	Subclavian	Femoral	PICC Line	Implanted Port	Tunneled Catheter
Placement Site	Neck	Under collarbone	Groin	Upper arm	Chest (surgically)	Chest (surgically)
Duration	Short-term (days)	Intermediate/Long-term	Short-term (emergency)	Intermediate-term (weeks-months)	Long-term (months-years)	Long-term (months-years)
Infection Risk	Moderate	Low	High	Low	Very Low	Low
Mobility Impact	Minimal	Minimal	Significant	Minimal	Very Minimal	Minimal
Ease of Access	High	High	High (emergency)	High (with training)	Low (requires needle)	Moderate
Comfort	Moderate	High	Low	High	High	High
Common Use	ICU, short-term	Prolonged IV therapy	Emergency, rapid access	Home IV therapy	Chemotherapy	Dialysis, home IV

The importance of proper site selection

The choice of central line site is a critical decision that balances the patient's medical needs, duration of treatment, and risk of complications. For instance, while a femoral line is quick to place in an emergency, it's often swapped for a less infection-prone site as soon as possible. A PICC line is an excellent alternative for patients who need prolonged therapy but don't require the invasiveness of a surgically placed port. Proper training in sterile technique and, where available, ultrasound guidance is crucial for reducing risks associated with all central line placements. For additional information on venous access, you can visit the National Institutes of Health website.

Conclusion

Central line placement is a common and essential medical procedure that utilizes several major veins in the body, including the internal jugular in the neck, the subclavian under the collarbone, and the femoral vein in the groin. Additionally, PICC lines are placed in the arm for intermediate-term access, while tunneled catheters and implanted ports provide long-term solutions. The selection of the insertion site is a carefully considered decision by the healthcare team, factoring in the patient's condition and the duration of treatment to ensure the safest and most effective care possible.

Frequently Asked Questions

The main insertion sites for a central line are the internal jugular vein in the neck, the subclavian vein beneath the collarbone, and the femoral vein in the groin. Peripherally inserted central catheters (PICC lines) are also considered a type of central line, but they are placed in a vein in the upper arm.

A central line is placed in the neck's internal jugular vein because it provides a direct, low-risk path to the superior vena cava, a large vein near the heart. This site is easily accessible and preferred for many critical care situations.

A central line is a broad term for catheters placed in major veins in the neck, chest, or groin. A PICC (Peripherally Inserted Central Catheter) is a specific type of central line inserted into a peripheral vein in the arm and advanced to a central vein. The main difference is the initial insertion point.

A femoral central line, placed in the groin, is most often used in emergency situations where rapid venous access is critical. However, due to its higher risk of infection and thrombosis, it is generally replaced with a different type of line as soon as the patient is stable.

The duration depends on the type. Non-tunneled lines used in emergency situations are temporary and may only stay for a few days. PICC lines can remain for weeks to months. Tunneled catheters and implanted ports are designed for long-term use, lasting many months or even years.

The procedure is performed under local anesthetic to numb the area, so patients feel minimal pain during insertion. Some mild discomfort or soreness may be felt at the insertion site for a few days afterward.

The choice of insertion site depends on multiple factors, including the patient's overall health, the reason for the central line, the intended duration, and the risk of complications. The healthcare provider will select the site that offers the best balance of safety and effectiveness for the specific clinical situation.