PICC and Midline catheters are not appropriate when there is poor vasculature access to the upper arm or when such vasculature access must be preserved for other uses. In general, Small Bore lines are similar to PICC lines in that, (a) regardless of entry point, they extend all the way to the Superior Vena Cava (SVC) or Inferior Vena Cava (IFC) large vein, located just above or below the heart and (b) such lines deliver medications and therapies directly to the heart, allowing prompt access to the bloodstream. Due to the size and placement of the Small Bore lines, such lines can deliver caustic and basic fluids such as IV antibiotics, chemotherapy, and IV nutrition over extended periods of time.
What are the main similarities among Axillary, Internal Jugular, and Femoral Lines?
Each of the Axillary, Internal Jugular, and Femoral lines provide most of the same benefits and contain most of the same potential complications of the other lines. Each line allows strong medications and large volumes of fluid to be infused, preserves peripheral veins, enables easier blood draws, and measures central venous blood pressure. Each line can remain in longer than other standard vascular access methods enabling fewer needle sticks and making it easier on the patient.
The insertion and guidance of the needles of the Axillary, Internal Jugular, and Femoral lines are all carefully performed using an ultrasound. The Modified Seldinger Technique (MST) is typically used for correct insertion and placement with confirmation of placement by x-ray. Line maintenance is generally similar across all lines such as in changing the dressing (bandages), flushing the line with fluids, and changing the catheter cap and such maintenance is critical to avoiding potential complications such as infections.
What are the main differences among Axillary, Internal Jugular, and Femoral Lines?
The main difference among the Axillary, Internal Jugular, and Femoral lines is the location of the needle insertion which is based on many factors including the patient’s medical history and vein use. The needle is inserted in veins in or around the chest, neck, or groin depending on the CVC.
The Axillary line is placed in the chest in either the Axillary or Subclavian vein, and the main benefit of this line is that it provides an effective option when there is limited access to the upper arm such as in poor vasculature, quadriplegia, or injury.
The Internal Jugular line is placed in the neck. In addition to providing a viable solution when there is limited access to the upper arm, the Internal Jugular CVC provides benefits to those patients who survived Breast Cancer or those with risk of Lymphedema, Deep Vein Thrombosis DVT, chronic Kidney Disease, or Upper Arm Cellulitis as this procedure helps avoid or mitigate potential complications that these specific patients may have when using other methods of obtaining vascular access.
The Femoral line is placed near the thigh or groin area avoiding the inguinal fold which can be a potential source of infection. This procedure provides many of the same benefits as the Internal Jugular line which come from avoiding the upper arm insertion site, and in addition, serves additional use cases such as when the patient has limited mobility, superior vena cava syndrome, or a new placed cardiac pacer.
Veins are not renewable resources. Vascular Wellness clinicians are highly trained and experienced in the various methods of vascular access procedures and evaluate each patient to provide the most clinically appropriate vascular access whether it is a standard or advanced method. Advanced methods such as those describe here are valuable tools to aiding in the life expectancy of the patient.