Venous and arterial lines

Question 1

Where can a patient’s information about current intravascular lines and other tubes be found on EPIC?

Answer 1

Epic → Snapshot → LDAs

Question 2

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?

Answer 2

Peripheral (tip out in periphery)

Midline (deeper than the periphery but before reaching the large thoracic veins)

Central (extending to the SVC / right atrium)

Question 3

Peripheral IVs can be used in patients under what scenarios?

Answer 3

• 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

Question 4

Central IVs should be used in patients under what scenarios?

Answer 4

• 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

Question 5

What are some of the types of central venous catheter?

Answer 5

1. Non-tunneled (often in the internal jugular, subclavian, or femoral veins)
2. Tunneled
3. Peripherally inserted central catheters (PICC line)
4. Implanted ports

Question 6

Generally, what lines are used for trauma patients?

Answer 6

Two, large-bore IVs in the periphery

Question 7

In emergency situations in which peripheral IV access is not feasible, what other two options exist for quick access to the venous system?

Answer 7

• Venous cutdown
• Intraosseous access

Question 8

What type of access site is typically used for routine hemodialysis?

Answer 8

An arteriovenous fistula

Question 9

Under what situations are arterial lines placed?

Answer 9

• For direct, real-time BP monitoring
• For arterial blood gas measurement

(Note: arterial lines are not used for medication administration.)

Question 10

Where are arterial lines often placed?

Answer 10

Radial a.

(can also be brachial, ulnar, dorsalis pedis, posterior tibial, or femoral)

Question 11

You need IV access for just a few days.

What do you choose?

Answer 11

Peripheral IV catheterization

Question 12

You need IV access for just under two weeks.

What are your options?

Answer 12

US-guided peripheral IV

Midline

CVC*

(*preferred for critically ill patients and hemodynamic monitoring)

Question 13

You need IV access for more than 2 weeks but less than a month.

What do you choose?

Answer 13

A PICC line

Question 14

You need IV access for more than 30 days.

What are your options?

Answer 14

A PICC line

A tunneled catheter

A port

Question 15

You need IV access for between 6 and 14 days.

What form of peripheral IV is appropriate?

Answer 15

US-guided

Question 16

_______ are a great go-to for venous access <30 days.

Answer 16

Midlines are a great go-to for venous access <30 days.

Question 17

List some of the many indications for a central line (i.e., a CVC, a PICC, tunneled, port.).

Answer 17

Vesicants, pressors, electrolytes (hypertonic saline, Ca²⁺chloride, potassium);

hemodialysis;

Swan-Ganz c., CVP, mixed venous O₂ sat.;

cooling c.;

temporary pacemaker

Question 18

List the appropriate lines for the following time periods of required venous access:

<6 days – _________

6-14 days – _________

14-30 days – _________

>30 days – _________

Answer 18

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

Question 19

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 – ________

Answer 19

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

Question 20

What is the main risk of peripheral IV access?

Answer 20

Vein erosion (occurs eventually in all PIVs)

Question 21

What is the main risk seen in PICC and midlines?

In which one is the risk higher?

Answer 21

• Bleeding, CLABSI, malposition, central vessel stenosis, thrombosis
• PICC > midline

Question 22

Can midlines tolerate irritants and vesicants?

Answer 22

No.

(The catheter tip still resides in the basilic or cephalic veins.)

Question 23

What are two examples of irritants or vesicants that would require central access for infusion?

Answer 23

• Chemotherapy
• Parenteral nutrition

Question 24

Which major veins carry an especially high risk of clotting if used for central line placement?

Answer 24

Femoral veins

Question 25

Which major veins are especially compressible, making them potentially useful for a central line in a patient with coagulopathy?

Answer 25

Femoral veins

Question 26

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.

Answer 26

• Remove the CVC
• Place in another neck vein

Avoid the femoral veins. Can also consider upper extremity PICC placement.