Arterial line
Any line inserted into the peripheral artery is considered an arterial line.
Arterial lines can be placed in multiple different arteries which include
- Radial
- Ulnar
- Brachial
- Axillary
- Posterior tibial
- Femoral
- Dorsalis pedis
Arterial lines are commonly used in ORs, ICUs and high risk settings. You cannot administer medications into arteries. Arterial lines have 2 main purposes
Continuous monitoring of blood pressure
Patients that may require continuous blood pressure monitoring include:
- Patients receiving IV vasopressors
- Patients who require live and strict BP monitoring
- Patients with an hypertensive emergency who require gradual lowering of BP
- Morbid obesity where a BP cuff may not be accurate
Take arterial blood gases (ABGs)
Patients that may require multiple ABGs include:
- Patients who may require multiple ABGs and have poor venous access
- Patients undergoing surgery
Central line
Indications
Irritating drugs: Commonly chemotherapy and vasopressors cannot be given through peripheral lines for risk of extravasation and irritation of local blood vessels. The risk of this injury is less due to the thicker walls of larger vessels of the SVC, IVC and right atrium, as well as the dilutional effect of these larger vessels on the irritating medication.
Hemodialysis: Dialysis typically involves regular “recyclicng” of large amounts of fluid which requires the use of a central line.
Fluids: Typically in a trauma situation peripheral large bore IVs are used since fluids are not necessarily irritating to small vessels like certain medications can be, and also because peripheral lines are much easier and faster to set up than central lines. However, in certain cases a central line may be indicated to deliver fluids over a peripheral line, for instance if the patient has sepsis and you want to measure their central venous pressure (although measuring CVP in all patients is not necessary).
Nutrition: Total parenteral nutrition must be delivered in the long term through a central line
Types of central lines (IV catheter placed in central vein)
CVC non-tunneled catheter
The line directly protrudes into vessels at the entry site which poses a higher risk of infection.
Non-tunneled catheters are inserted into the internal jugular vein, subclavian vein, axillary vein or femoral vein.
The tip of the line is found between the SVC and right atrium.
Typically used for short term use (maximum 3-4 weeks).
Commonly used for patients with difficult IV access who require short term use of irritant drugs, parenteral nutrition or vasopressors.
CVC tunneled catheter (Hickman’s catheter)
Tunneled catheter is similar to a non-tunneeld catheter in that it will deliver fluids directly to the SVC, IVC or right atrium, but it has a slight modification in that the opening of the line is not at the same location as the entry into the vessels or right atrium. It is called a tunneled catheter because the catheter is tunneled under the skin from surface of the skin to the vessels of the heart.
Tunneled catheters are inserted into the internal jugular vein and subclavian vein.
The tip of the line is found between the SVC and right atrium.
Typically used for long term use (months, years).
Commonly used for dialysis and chemotherapy.
PICC line
The catheter is inserted into a peripheral vein and coarsed until it reaches the right atrium or SVC. Used commonly in TPN, long term antibiotics and chemotherapy. Reduced risk of infection compared to non tunneled and tunneled catheter but has increased risk of upper extremity DVT compared to central venous catheters.
PICC lines are inserted into basilic vein, cephalic vein or brachial vein.
The tip of the line is found between the SVC and right atrium.
Commonly used for difficult IV access, chemotherapy and parenteral nutrition.
Port-a-cath
Reservoir is implanted under skin through an OR procedure. A catheter extends from the port and then advanced into a nearby vein which drains into the SVC. Medications are directly administered into the silicon covered port. Used commonly for chemotherapy. Ports have a lower risk of infection compared to central venous catheter or PICC catheter and are more comfortable to use and maintain than PICC lines.
Ports are inserted into the internal jugular vein and subclavian vein.
The tip of the line is found between the SVC and right atrium.
Typically used for long term use (months, years).
Commonly used for chemotherapy.