Lines Flashcards by Charlotte Reed

What are the types of peripheral line?

Cannula

Midline

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What are the types of central line?

4 or 5 lumen central line

Vascath

PICC

Hickman

Portacath

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What are the short term lines?

Peripheral lines: Cannula, Midline

Central lines: 4/5L central line, Vascath

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What are the long term lines?

Central lines: PICC, Hickman, Portacath

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Where do central lines usually site?

Large veins, SVC or IVC

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What are the benifits of peripheral lines?

Require less skill to site

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What are the benifits of central lines?

Can take blood repeatedly

No drug restrictions

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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

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What drugs are too irritant to give peripherally?

Glucose 50%

Neat KCL

Diluted KCL > 10mmol/hour

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

Aspirate and discard first blood (unless for line culture)

Take sample

Flush

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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

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What are the sizes of cannula (ascending)?

Blue (smallest)

Pink

Green

Grey

Orange

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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

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

Pink

(+green, grey and orange)

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What is a midline?

Peripheral line, a longer version of a cannula

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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