Venous and arterial lines Flashcards
Where can a patient’s information about current intravascular lines and other tubes be found on EPIC?
Epic → Snapshot → LDAs
What are the three major forms of intravenous access in non-emergent situations in terms of where the catheter tip is located within the patient’s body?
Peripheral (tip out in periphery)
Midline (deeper than the periphery but before reaching the large thoracic veins)
Central (extending to the SVC / right atrium)
Peripheral IVs can be used in patients under what scenarios?
- Those who only need short-term access (routinely removed and replaced as needed every 3-4 days)
- Those who are not receiving medications that are highly toxic to the small veins
Central IVs should be used in patients under what scenarios?
- Those requiring long-term venous access (~6 months)
- Those requiring medications that would damage small veins (e.g., chemotherapy)
- Those requiring CVP monitoring and/or central oxygen saturation measurement
What are some of the types of central venous catheter?
- Non-tunneled (often in the internal jugular, subclavian, or femoral veins)
- Tunneled
- Peripherally inserted central catheters (PICC line)
- Implanted ports
Generally, what lines are used for trauma patients?
Two, large-bore IVs in the periphery
In emergency situations in which peripheral IV access is not feasible, what other two options exist for quick access to the venous system?
- Venous cutdown
- Intraosseous access
What type of access site is typically used for routine hemodialysis?
An arteriovenous fistula
Under what situations are arterial lines placed?
- For direct, real-time BP monitoring
- For arterial blood gas measurement
(Note: arterial lines are not used for medication administration.)
Where are arterial lines often placed?
Radial a.
(can also be brachial, ulnar, dorsalis pedis, posterior tibial, or femoral)
You need IV access for just a few days.
What do you choose?
Peripheral IV catheterization
You need IV access for just under two weeks.
What are your options?
US-guided peripheral IV
Midline
CVC*
(*preferred for critically ill patients and hemodynamic monitoring)
You need IV access for more than 2 weeks but less than a month.
What do you choose?
A PICC line
You need IV access for more than 30 days.
What are your options?
A PICC line
A tunneled catheter
A port
You need IV access for between 6 and 14 days.
What form of peripheral IV is appropriate?
US-guided
_______ are a great go-to for venous access <30 days.
Midlines are a great go-to for venous access <30 days.
List some of the many indications for a central line (i.e., a CVC, a PICC, tunneled, port.).
Vesicants, pressors, electrolytes (hypertonic saline, Ca2+chloride, potassium);
hemodialysis;
Swan-Ganz c., CVP, mixed venous O2 sat.;
cooling c.;
temporary pacemaker
List the appropriate lines for the following time periods of required venous access:
<6 days – _________
6-14 days – _________
14-30 days – _________
>30 days – _________
List the appropriate lines for the following time periods of required venous access:
<6 days – PIV, midline
6-14 days – Midline
14-30 days – Midline, PICC, +/- tunneled
>30 days – PICC, tunneled, port
List the appropriate lines for the following time periods of frequent phlebotomy (≥3 per day):
<6 days – ________
6-14 days – ________
14-30 days – ________
>30 days – ________
List the appropriate lines for the following time periods of frequent phlebotomy (≥3 per day):
<6 days – Midline (PICC??)
6-14 days – +/- Midline. PICC
14-30 days – PICC
>30 days – PICC, tunneled, port
What is the main risk of peripheral IV access?
Vein erosion (occurs eventually in all PIVs)
What is the main risk seen in PICC and midlines?
In which one is the risk higher?
- Bleeding, CLABSI, malposition, central vessel stenosis, thrombosis
- PICC > midline
Can midlines tolerate irritants and vesicants?
No.
(The catheter tip still resides in the basilic or cephalic veins.)
What are two examples of irritants or vesicants that would require central access for infusion?
- Chemotherapy
- Parenteral nutrition
Which major veins carry an especially high risk of clotting if used for central line placement?
Femoral veins
Which major veins are especially compressible, making them potentially useful for a central line in a patient with coagulopathy?
Femoral veins
If a central venous catheter placed in a neck vein clots off, what should be done?
Assume it does not respond to flushing or alteplase therapy.
- Remove the CVC
- Place in another neck vein
Avoid the femoral veins. Can also consider upper extremity PICC placement.
