A Groshong catheter is a type of long-term central venous catheter with a unique built-in valve at its tip that prevents blood from flowing back into the tube. This valve is what sets it apart from other tunneled catheters: it stays closed when the catheter isn’t in use, which means it can be maintained with simple saline flushes instead of the blood-thinning solution (heparin) that most other central lines require. Groshong catheters are commonly used for chemotherapy, long-term IV medications, blood draws, and parenteral nutrition.
How the Groshong Valve Works
Most central catheters are open-ended tubes. When nothing is being infused, blood can creep back into the tip, which creates a clotting risk and requires regular heparin flushes to keep the line clear. The Groshong catheter solves this with a three-position valve built into its closed, rounded tip. When fluid is infused, the valve opens outward to let medication flow into the bloodstream. When blood is being drawn, suction pulls the valve inward. When nothing is happening, the valve stays sealed shut, acting as a barrier against blood backflow and air entry.
This design eliminates the need for heparin locking between uses. Instead, flushing with normal saline is enough to keep the catheter functioning properly. For patients who use their catheter intermittently or who have bleeding risks that make heparin problematic, this is a meaningful advantage.
How It’s Placed
A Groshong catheter is a tunneled catheter, meaning it isn’t inserted directly into a vein at the skin surface. Instead, a surgeon or interventional radiologist threads the catheter under the skin for several inches before it enters a large vein, typically the internal jugular vein in the neck. The catheter tip sits in the superior vena cava, the large vein just above the heart, where high blood flow helps dilute medications quickly.
The tunneling serves two purposes. First, it creates distance between the skin entry point (usually on the chest) and the vein entry point, which reduces infection risk. Second, the catheter has a small fabric cuff (made of a material called Dacron) positioned within the tunnel. Over two to three weeks, tissue grows into this cuff, anchoring the catheter in place and creating an additional barrier against bacteria traveling along the outside of the tube.
Placement is typically done under local anesthesia and fluoroscopic (real-time X-ray) guidance. The procedure takes roughly 30 to 60 minutes. You’ll feel pressure and some stinging from the local anesthetic, but the insertion itself is not typically painful. A small portion of the catheter remains outside the body on your chest, which is where connections for infusions and blood draws are made.
Daily Care and Maintenance
Keeping a Groshong catheter working well comes down to two things: regular flushing and proper dressing care.
Flushing
Because the Groshong valve eliminates the need for heparin, you flush with normal saline only. The recommended flush volume is at least 10 mL before and after giving medications or drawing blood. After infusing thicker substances like blood products or parenteral nutrition, a 20 mL saline flush is recommended to rinse the catheter thoroughly. When the catheter isn’t being used regularly, flushing intervals vary, but weekly flushing is a common minimum for long-term tunneled catheters. Your care team will give you a specific schedule based on how often you’re using the line.
Dressing Changes
The skin around the catheter’s exit site needs to be kept clean and covered. Dressing changes are generally done about once a week, though you should change the dressing sooner if it becomes loose, wet, or visibly dirty. During each change, the skin around the exit site is cleaned with an antiseptic solution (typically chlorhexidine) for at least 30 seconds and allowed to air dry completely before a new sterile dressing is applied. You or a caregiver can learn to do this at home, and your healthcare team will walk you through the technique before discharge.
Groshong vs. Hickman Catheters
The Hickman catheter is the most common comparison point. Both are tunneled, cuffed central venous catheters designed for long-term use. The core difference is the tip design: Hickman catheters have an open-ended tip and require heparin flushes to prevent clotting, while Groshong catheters use the three-position valve and need only saline.
One study comparing the two found that patients with Hickman catheters actually experienced fewer overall complications, including fewer issues with one-way flow and intermittent blockages. This doesn’t mean the Groshong is a poor choice. It means the valve mechanism, while it simplifies maintenance, can occasionally cause its own problems, particularly partial occlusions if the valve doesn’t open or close cleanly. The choice between the two often depends on a patient’s specific treatment plan, how frequently the catheter will be used, and whether avoiding heparin is clinically important.
Possible Complications
Like all central venous catheters, Groshong catheters carry risks that fall into a few categories.
- Infection: Central line-associated bloodstream infections are the most serious concern. In studies of similar catheter types, infection rates have been measured at roughly 0.5 to 0.75 per 1,000 catheter-days, which translates to a relatively low daily risk but a meaningful cumulative risk over months of use. Signs include fever, chills, redness or drainage at the exit site, and feeling generally unwell.
- Blood clots: Deep vein thrombosis can form around the catheter in the vein. Reported rates range from about 0.3 to 1.5 per 1,000 catheter-days depending on the catheter type and patient population. Symptoms include swelling, pain, or a feeling of tightness in the arm, neck, or chest on the side of the catheter.
- Occlusion: The catheter can become partially or fully blocked, making it difficult to draw blood or infuse fluids. This is sometimes related to the valve mechanism itself or to buildup of medication residue inside the line. Consistent flushing with adequate saline volumes is the primary prevention strategy.
- Catheter migration or damage: Over time, the catheter tip can shift position, or the external portion can develop cracks or tears from repeated use. Clamps should never be applied directly to the catheter tubing, and the external line should be handled carefully.
Who Typically Gets a Groshong Catheter
Groshong catheters are most often placed in people who need reliable venous access for weeks to months. Common situations include chemotherapy regimens that run over multiple cycles, long courses of IV antibiotics, total parenteral nutrition for people who can’t eat by mouth, and frequent blood draws in patients with difficult peripheral veins. They’re also sometimes preferred for patients with clotting disorders or low platelet counts, where the heparin required by other catheter types could increase bleeding risk.
The catheter can remain in place for months or even longer, as long as it’s functioning well and free from infection. Removal is a brief outpatient procedure. Once the Dacron cuff has been in place long enough for tissue to grow into it (usually a few weeks), a small amount of local anesthetic is used and the catheter is gently dissected free and pulled out. Most people describe removal as easier and less uncomfortable than the original placement.