Lines

Question 1

What are the types of peripheral line?

Answer 1

Cannula

Midline

Question 2

What are the types of central line?

Answer 2

4 or 5 lumen central line

Vascath

PICC

Hickman

Portacath

Question 3

What are the short term lines?

Answer 3

Peripheral lines: Cannula, Midline

Central lines: 4/5L central line, Vascath

Question 4

What are the long term lines?

Answer 4

Central lines: PICC, Hickman, Portacath

Question 5

Where do central lines usually site?

Answer 5

Large veins, SVC or IVC

Question 6

What are the benifits of peripheral lines?

Answer 6

Require less skill to site

Question 7

What are the benifits of central lines?

Answer 7

Can take blood repeatedly

No drug restrictions

Question 8

What are the downsides to peripheral lines?

Answer 8

Can tissue/fall out

Can only take blood when first inserted

Some drugs too irritant to give peripherally

Question 9

What drugs are too irritant to give peripherally?

Answer 9

Glucose 50%

Neat KCL

Diluted KCL > 10mmol/hour

Question 10

How do you take a blood sample from a central line?

Answer 10

Aspirate and discard first blood (unless for line culture)

Take sample

Flush

Question 11

What are the general uses of a cannula?

Answer 11

Most prescriptions

Taking blood when 1st inserted before flush

Blood cultures when 1st inserted (some trusts)

Time restricted usually around 72hrs, short term

Question 12

What are the sizes of cannula (ascending)?

Answer 12

Blue (smallest)

Pink

Green

Grey

Orange

Question 13

What is important to realise about the size of the cannula in regards to the time to infuse?

Answer 13

Exponential increase as flow rate is proportional to r⁴

Question 14

What colour of cannula (and above) is required for blood transfusions?

Answer 14

Pink

(+green, grey and orange)

Question 15

What is a midline?

Answer 15

Peripheral line, a longer version of a cannula

Question 16

When is a midline often used?

Answer 16

In patients who are difficult to cannulate

If requires treatment for 14-30 days i.e. antibiotics

Question 17

By what technique is a midline inserted?

Answer 17

Seldinger technique

(Wire and USS guided)

Question 18

How can a midline be used and what other line does it mimic?

Answer 18

Same as a cannula

Looks like a PICC line so be careful not to mistake them

Question 19

What are the uses of a 4 or 5 line central line?

Answer 19

Central line - ITU and theatre favourite

Access for up to 14 days

Can insert multiple different medications into it simultenously and less likely to fail.

CVP (central venous pressure measurement)

Taking bloods, flush with saline after

Question 20

What is the appearance and site of a 4/5 lumen central line?

Answer 20

15-20 cm long line inserted into internal jugular, subclavian or femoral vein.

Terminates in SVC or IVC

Question 21

How is a 4/5 lumen central line inserted?

Answer 21

Seldinger technique, fully aespetically

If internal jugular of SC insertion need CXR

Question 22

What is a Vascath?

What is it used for?

Answer 22

Central line - 15-20cm long line inserted into femoral or jugular vein terminates in IVC or SVC. Has two 18G lumens

Can stay in place for <14 days

For haemodialysis or haemofiltration in critical care - renal replacement therapy.

Question 23

How is a Vascath inserted?

Answer 23

Seldinger technique, aseptically

If internal jugular insertion need CXR to exclude pneumothorax and check line position

Question 24

How must a Vascath be treated when not in use?

Answer 24

Flushed with herparin solution

Question 25

What is a PICC line?

Answer 25

Long term, central line

30-60 cm inserted into the cephalic or brachial vein and terminating in the SVC

Question 26

What is a PICC line used for?

Answer 26

Long term central vein access >14 days

Some chemotherapy

(can be used to measure CVP but uncommon)

Question 27

What do you need to know about PICC lines?

Answer 27

Flushed with heparin

Precious - don’t use without senior consultation

Can be mistaken with midline - be careful!

Question 28

What is a Hickman line?

Answer 28

Tunneled central, long-term, cannula.

Works like an internal jugular or subclavian central line but has a tunnelled section subcutaneously between vein entry and skin exit.

Question 29

What is a Hickman line used for?

Answer 29

Tunneling confers benifits from infection, allowing lines to stay in for many weeks

Often used for chemotherapy

Question 30

What is important to know about a Hickman line?

Answer 30

Flushed with heparin

PRECIOUS LINE - Don’t use without explicit senior request

After tunelled section, port comes out of skin, usually below clavicle

Question 31

What is a port-a-cath?

Answer 31

Long term, tunelled, central line (similar to Hickman)

Works like an internal jucular or subclavian central line with subcut tunelled section.

Port for injections is a small, subcutaneous resevoir under the skin, no external port.

Accessed by puncturing through the skin with a Huber needle and injecting into resevoir

Question 32

What is a port-a-cath used for?

Answer 32

Tunelling confers benefits from infection, allowing line to stay in situ for many weeks.

Question 33

What rules apply to port-a-caths?

Answer 33

Flushed with Heparin

PRECIOUS LINE - Do not use unless told specifically by senior.

Question 34

What is an arterial line?

Answer 34

A cannula size (Floswitch) or midline size (Leadercath-vygon) line which sits in an artery - radial, brachial or femoral.

Question 35

What is an arterial line used for?

Answer 35

Continuous monitoring of blood pressure

Can aspirate off repeated blood samples from an arterial line

Question 36

What do you need to know about the types and function of arterial lines?

Answer 36

Floswitch (small) doesn’t fit into small arteries, inserted like cannula.

Vygon insterted by Seldinger technique, all size arteries

Works by connecting to a transduced which records blood pressure every second.

Question 37

How do you take a blood sample from an arterial line?

Answer 37

Take first sample and dispose

Use the second sample