 For many sick children, central venous catheters, or central lines, are lifelines. The tubes are entryways for critical nutrients or medicines. Threaded inside veins, they can deliver needed fluids and allow for frequent blood draws without needle pricks. But catheters can also be dangerous. Tubes can break, clots can form, and contamination is a constant worry. Here, we'll review the latest research on pediatric central lines, including placement, complications, and how to avoid infection. Depending on the need, catheters can stay in for a few weeks, to months or years. They're inserted into the veins in the neck, arm, or groin, in the operating room, interventional radiology, or at the bedside. Regardless of where the central line is placed, the current standard of care is to use an ultrasound machine to guide placement. With this visual aid, fewer attempts are needed for successful insertion and there are fewer complications. One complication of central lines is tube fracture. Internal tubing can snap if the catheter gets caught between the collarbone and the first rib, something called pinch-off syndrome. Although rare, this can block blood flow to the heart and requires immediate removal. Symptoms may include collarbone pain, numbness, tingling, weakness, or swelling in the arms, an irregular heartbeat, or extra resistance when trying to push fluids through the catheter. However, there may be no symptoms, so caregivers should be vigilant. The tubing on the outside of the body can also break. While this can usually be repaired, it can increase the risk of infection. Infections can be life-threatening. Because central lines involve placing tubes in blood vessels, an infection can quickly lead to sepsis. Unfortunately, these infections are common enough to have their own acronym, CLABSIS. At highest risk are children age 3 or younger, those with low body weight, and kids or infants on long-term nutrition. The sugars, fats, and proteins flowing through catheters create perfect conditions for the rapid expansion of microorganisms. There are ways to reduce the risk of infection. During catheter insertion, doctors and nurses should make every effort to prevent contamination, including the use of a sterile gown, cap, and full body drape. A checklist should be used to make sure these precautions are followed. Prior to placement and during dressing changes, antimicrobial agents should be used to cleanse the skin. In neonates, however, be careful. Some agents can burn delicate skin, and iodine can harm developing thyroids. The end caps on central line tubes must also be scrubbed with an antiseptic before accessing the catheter hub. Children receiving lipids or blood products should have their tubing replaced within 24 hours. But otherwise, the tubing should not be changed more often than every four days. Catheters that are no longer necessary should be promptly removed. Finally, recent research suggests that ethanol locks are effective at battling the formation of biofilms, which are a source of infection inside the catheter tubing. Additional research may soon reveal whether ethanol can also be used therapeutically once a child develops a catheter infection. For now, the CDC recommends that hospitals use standardized protocols and dedicated multidisciplinary teams. By paying particular attention to central lines, kids won't get more catheter than they really need, and doctors and nurses will be able to protect and treat their tiniest patients.