Central Lines

Question 1

What are central lines?

Answer 1

Catheters placed into the major veins (central veins) via subclavian, internal jugular, or femoral vein approaches

Question 2

What major complications result from placement?

Answer 2

Pneumothorax (always get a post-placement CXR)
Bleeding
Malposition (i.e., into the neck)
Dysrhythmias

Question 3

In long-term central lines, what does the “cuff” do?

Answer 3

Allows ingrowth of fibrous tissue which holds the line in place and forms a barrier to the advance of bacteria

Question 4

What is a Hickman or Hickman-type catheter?

Answer 4

External central line tunneled under the skin with a “cuff”

Question 5

What is a Port-A-Cath?

Answer 5

Central line that has a port buried under the skin, which must be accessed through the skin (percutaneously)

Question 6

What is a “cordis”?

Answer 6

Large central line catheter, used for massive fluid resuscitation or for placing a Swan-Ganz catheter

Question 7

If you try to place a subclavian central line unsuccessfully, what must you do before trying the other side?

Answer 7

Get a CXR - bilateral PTX can be fatal

Question 8

How can diameter in mm be determined from a French measurement?

Answer 8

Divide the French size by 3.14

Question 9

What are the signs of a central line infection?

Answer 9

Unexplained hyperglycemia, fever, mental status change, hypotension, tachycardia -> shock, pus, and erythema at central line site

Question 10

What is a central line-associated bloodstream infection (CLABSI)?

Answer 10

Central line in place >2 days
+Blood culture
No other source of infection

Question 11

What is the most common cause of “catheter-related bloodstream infections”?

Answer 11

Coag-negative staphylococci (33%), followed by enterococci, S. aureus, GN rods

Question 12

When should central lines be changed?

Answer 12

When they are infected; there is NO advantage to changing them every 7 days in non-burn patients

Question 13

What central line infusion increases the risk of infection?

Answer 13

Hyperal (TPN)

Question 14

What is the treatment for cenral line infection?

Answer 14

Remove central line (send for culture) +/- IV ABX

Place NEW central line in a different site

Question 15

When should peripheral IV short angiocatheters be changed?

Answer 15

Every 72-96 hours

Question 16

Describe the location of the subclavian vein.

Answer 16

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

Question 17

What is a key landmark in placement of a subclavian central line?

Answer 17

One fingerbreadth lateral to the junction of the middle and medial thirds of the clavicle

Question 18

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.

Answer 18

Axillary; first rib; anterior scalene muscle; brachicephalic

Question 19

The subclavian vein follows the subclavian artery and is separated from the artery by the insertion of ___.

Answer 19

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)