Lines Flashcards
What are the types of peripheral line?
Cannula
Midline
What are the types of central line?
4 or 5 lumen central line
Vascath
PICC
Hickman
Portacath
What are the short term lines?
Peripheral lines: Cannula, Midline
Central lines: 4/5L central line, Vascath
What are the long term lines?
Central lines: PICC, Hickman, Portacath
Where do central lines usually site?
Large veins, SVC or IVC
What are the benifits of peripheral lines?
Require less skill to site
What are the benifits of central lines?
Can take blood repeatedly
No drug restrictions
What are the downsides to peripheral lines?
Can tissue/fall out
Can only take blood when first inserted
Some drugs too irritant to give peripherally
What drugs are too irritant to give peripherally?
Glucose 50%
Neat KCL
Diluted KCL > 10mmol/hour
How do you take a blood sample from a central line?
Aspirate and discard first blood (unless for line culture)
Take sample
Flush
What are the general uses of a cannula?
Most prescriptions
Taking blood when 1st inserted before flush
Blood cultures when 1st inserted (some trusts)
Time restricted usually around 72hrs, short term
What are the sizes of cannula (ascending)?
Blue (smallest)
Pink
Green
Grey
Orange
What is important to realise about the size of the cannula in regards to the time to infuse?
Exponential increase as flow rate is proportional to r4
What colour of cannula (and above) is required for blood transfusions?
Pink
(+green, grey and orange)
What is a midline?
Peripheral line, a longer version of a cannula
When is a midline often used?
In patients who are difficult to cannulate
If requires treatment for 14-30 days i.e. antibiotics
By what technique is a midline inserted?
Seldinger technique
(Wire and USS guided)
How can a midline be used and what other line does it mimic?
Same as a cannula
Looks like a PICC line so be careful not to mistake them
What are the uses of a 4 or 5 line central line?
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
What is the appearance and site of a 4/5 lumen central line?
15-20 cm long line inserted into internal jugular, subclavian or femoral vein.
Terminates in SVC or IVC
How is a 4/5 lumen central line inserted?
Seldinger technique, fully aespetically
If internal jugular of SC insertion need CXR
What is a Vascath?
What is it used for?
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.
How is a Vascath inserted?
Seldinger technique, aseptically
If internal jugular insertion need CXR to exclude pneumothorax and check line position
How must a Vascath be treated when not in use?
Flushed with herparin solution
What is a PICC line?
Long term, central line
30-60 cm inserted into the cephalic or brachial vein and terminating in the SVC
What is a PICC line used for?
Long term central vein access >14 days
Some chemotherapy
(can be used to measure CVP but uncommon)
What do you need to know about PICC lines?
Flushed with heparin
Precious - don’t use without senior consultation
Can be mistaken with midline - be careful!
What is a Hickman line?
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.
What is a Hickman line used for?
Tunneling confers benifits from infection, allowing lines to stay in for many weeks
Often used for chemotherapy
What is important to know about a Hickman line?
Flushed with heparin
PRECIOUS LINE - Don’t use without explicit senior request
After tunelled section, port comes out of skin, usually below clavicle
What is a port-a-cath?
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
What is a port-a-cath used for?
Tunelling confers benefits from infection, allowing line to stay in situ for many weeks.
What rules apply to port-a-caths?
Flushed with Heparin
PRECIOUS LINE - Do not use unless told specifically by senior.
What is an arterial line?
A cannula size (Floswitch) or midline size (Leadercath-vygon) line which sits in an artery - radial, brachial or femoral.
What is an arterial line used for?
Continuous monitoring of blood pressure
Can aspirate off repeated blood samples from an arterial line
What do you need to know about the types and function of arterial lines?
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.
How do you take a blood sample from an arterial line?
Take first sample and dispose
Use the second sample
