Central Venous Catheter Lines

Central Venous Catheter Lines include PICC Lines and Small Bore Axillary Lines, Internal Jugular Lines, and Femoral Lines.  Vascular Wellness places more Standard and Advanced Central Lines than virtually any other external provider in the southeast.  This page describes, in general, when these Central Lines are clinically appropriate. Vascular Wellness also places Large Bore Lines such as Vas Caths for Dialysis and Quad Lumen Lines and these lines are described on other pages.

Central Venous Catheter Lines

Central Venous Catheter Lines consist of the following, in order of escalation path:
• PICC – Peripherally Inserted Central Catheter Lines
• Small Bore Axillary Central Catheter Lines (infrequently used)
• Small Bore Internal Jugular Central Catheter Lines
• Small Bore Femoral Central Catheter Lines
Central Venous Catheters & Midline Catheter (non-central)

Central Venous Catheter Lines & Midline Catheter (non-central)

PICC Line

PICC Line

Central Venous Catheter Lines

| PICC Lines

PICC Lines are the most used and least intrusive method for obtaining Vascular Access through a central venous line provided it is clinically indicated and appropriate, which means the following:
• pH IV medications or fluids with pH <5 or >9*
• TPN – Total Parenteral Nutrition, a method of getting nutrition into the body through the veins
• CVP – Central Venous Pressure Monitoring, the most accurate blood pressure reading available
• Extended access need > 5 days
• No current Central Venous Line Access (e.g., port, tunneled catheter)
• Current Central Venous Line Access not supportive of expected therapy(s)

Small Bore Central Venous Catheter Lines

| Axillary Lines

Axillary Lines are the next step for Vascular Access if clinically indicated or PICC Lines are not successful.  Indications of use include:
• Poor vasculature for access in upper arm
• Quadriplegia
• Severe upper extremity contracture or injury

Small Bore Axillary Central Venous Line

Small Bore Axillary Line

Small Bore Internal Jugular Central Venous Line

Small Bore Internal Jugular Line

Small Bore Central Venous Catheter Lines

| Internal Jugular Lines

Internal Jugular Lines provide the next option, assuming all PICC and Axillary Line indications are met and such Lines are not available or unsuccessful, and if the following indications of use are present:
• Chronic Kidney Disease***
• Future AV Fistula preservation or presence of AV Fistula (abnormal connection between an artery and vein)**
• Bilateral Radical Mastectomy
• Bilateral Upper Extremity Cellulitis
• Current Upper Extremity DVT (Deep Vein Thrombosis)

Small Bore Central Venous Catheter Lines

| Femoral Lines

Femoral Lines are some of the last options to obtaining Vascular Access using a Small Bore Central Venous Catheter Line.  If all PICC Line, Axillary Line, and Internal Jugular Line indications are met, and such Lines are not available or unsuccessful, then a Small Bore Femoral Line is appropriate if the following indications of use are present:

• SVC syndrome – Superior Vena Cava Syndrome, a block or pinching of the superior vena cava which is the vein that carries blood from head, neck and chest to the heart
• Exhausted all other modes of access

Small Bore Femoral Central Venous Line

Small Bore Femoral Line in the mid-thigh

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References

*Infusion Nursing Standards of Practice. Journal of Intravenous Nursing, (15) January-February 2011.

** Centers for Disease Control and Prevention. (2011). Guidelines for the prevention of intravascular catheter-related infections. Retrieved January 2015. http://www.cdc.gov/hipac/pdf/guidelines/bsi-guidelines-2011.pdf

*** Guidelines for Venous Access in Patients with Chronic Kidney Disease. (2009) A position statement form the American Society of Diagnostic and Interventional Nephrology Clinical Practice and the Association for Vascular Access

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Vascular Wellnesssm provides clinical vascular access nursing services at the bedside across the Southeast to a diverse client base including Tertiary Hospitals, Community Hospitals, Long Term Acute Care Hospitals, Skilled Nursing Facilities, Surgical and Outpatient Centers,  Hospice, and At-Home care.

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