Central Lines Flashcards
What are central lines?
Catheters placed into the major veins (central veins) via subclavian, internal jugular, or femoral vein approaches
What major complications result from placement?
Pneumothorax (always get a post-placement CXR)
Bleeding
Malposition (i.e., into the neck)
Dysrhythmias
In long-term central lines, what does the “cuff” do?
Allows ingrowth of fibrous tissue which holds the line in place and forms a barrier to the advance of bacteria
What is a Hickman or Hickman-type catheter?
External central line tunneled under the skin with a “cuff”
What is a Port-A-Cath?
Central line that has a port buried under the skin, which must be accessed through the skin (percutaneously)
What is a “cordis”?
Large central line catheter, used for massive fluid resuscitation or for placing a Swan-Ganz catheter
If you try to place a subclavian central line unsuccessfully, what must you do before trying the other side?
Get a CXR - bilateral PTX can be fatal
How can diameter in mm be determined from a French measurement?
Divide the French size by 3.14
What are the signs of a central line infection?
Unexplained hyperglycemia, fever, mental status change, hypotension, tachycardia -> shock, pus, and erythema at central line site
What is a central line-associated bloodstream infection (CLABSI)?
Central line in place >2 days
+Blood culture
No other source of infection
What is the most common cause of “catheter-related bloodstream infections”?
Coag-negative staphylococci (33%), followed by enterococci, S. aureus, GN rods
When should central lines be changed?
When they are infected; there is NO advantage to changing them every 7 days in non-burn patients
What central line infusion increases the risk of infection?
Hyperal (TPN)
What is the treatment for cenral line infection?
Remove central line (send for culture) +/- IV ABX
Place NEW central line in a different site
When should peripheral IV short angiocatheters be changed?
Every 72-96 hours
Describe the location of the subclavian vein.
Courses behind the medial third of the clavicle, joins the internal jugular vein to drain into the SVC
Lies anterior and inferior to the subclavian artery
Dome of the right lung lies behind the vessels
What is a key landmark in placement of a subclavian central line?
One fingerbreadth lateral to the junction of the middle and medial thirds of the clavicle
Each subclavian vein is a continuation of the ___ vein and runs from the outer border of the ___ to the medial border of the ___. From here it joins with the internal jugular vein to form the ___ vein.
Axillary; first rib; anterior scalene muscle; brachicephalic
The subclavian vein follows the subclavian artery and is separated from the artery by the insertion of ___.
Anterior scalene; thus, the subclavian vein lies anterior to the anterior scalene while the subclavian artery lies posterior to the anterior scalene (and anterior to the middle scalene)
