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.

VASCULAR ACCESS SPECIALISTS

As Vascular Access Specialists, Vascular Wellness nurse clinicians are Vascular Access Board Certified (VA-BC), insured, skill-verified, and salaried W2 employees.  Vascular Wellness requires bi-annual skill verification ensuring adherence to proprietary policies, procedures, competencies, and best practices.  We focus on holistic and comprehensive care and do not follow the pay per procedure model plus performance bonuses used by others that may create some adverse incentives for speed at the bedside versus holistic medical care helping to ensure the placement of the right line at the right time, the first time.  In fact, Vascular Wellness employs a Director of Research and Development who not only helps us stay up to date on best practices but helps us continue to innovate and improve upon Vascular Access Services.

Vascular Access Specialists from Vascular Wellness

Vascular Access Specialists practice holistic medical care, meaning talking to the patient, addressing questions and fears, and performing a comprehensive medical review.  Prior to delivering any Vascular Access procedure, the Vascular Wellness clinician reviews the patient’s medical record, including history and lab reports, and independently verifies and confirms the doctor’s order.  If our clinician has questions or disagrees with the prescribing doctor, the clinician will consult with the doctor. Our Vascular Access Specialists have earned the trust of many doctors, and such doctors will defer to the clinician’s recommendation by ordering a “consult” as compared to a specific line.  Patient safety and vein preservation are critical – which is why a holistic, comprehensive evaluation and Advanced Lines are significant.  Other companies claiming to be Vascular Access Specialists may not follow this same approach frustrating medical doctors and nurses primarily because those 1099 Contractor PICC nurses do not place Advanced Lines (i.e, no options other than PIVs, Midlines, and PICCs) and get paid on a pay per procedure model.

In states where nurses are permitted, as Vascular Access Specialists, Vascular Wellness clinicians can provide immediate X-Ray Clearance of lines when tip confirmation is not available or appropriate and X-Ray confirmation must be used. This saves money, time, and coordination with a Radiologist or other doctor and enables the lines to be used immediately to avoid delaying treatment. Quicker therapy leads to better outcomes.

As Vascular Access Specialists, Vascular Wellness uses top rated and hospital preferred supplies from Becton Dickinson, formerly Bard (BD). Superior supplies and services help mitigate the potential for poor outcomes such as bad placement, clotting, infections, and other adverse events.  Other companies that are not Vascular Access Specialists may opt for inferior supplies and older equipment.

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

Learn why our clients & patients value our Clinical Expertise & Advanced Lines

Read our Nurse Clinicians in Action series highlighting clinical cases in which our comprehensive vascular access services made all the difference.

Want more than just a PICC Service?

We offer timely, innovative, and advanced vascular access services at the bedside, with full administrative support, from skilled employees who care.

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

Want more than just a PICC Service or PICC Team?
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We are Vascular Access Specialists and here to help and answer your questions.

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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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151 Quarrystone Circle
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Cary, NC 27519
919-226-3694

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