Central Venous Catheter Lines

Vascular Wellness clinicians provide more Central Venous Catheter Lines than virtually any other external provider in the southeast and perform the most advanced procedures permitted by the applicable state nursing board. This page describes, in general, when these central lines are clinically appropriate.

Central Venous Catheter Lines

Central Venous Catheter Lines (i.e., Advanced Vascular Access) consist of the following, in order of escalation path:
• PICC – Peripherally Inserted Central Catheter Line
• Small Bore Axillary Central Catheter Line
• Small Bore Internal Jugular Central Catheter Line
• Small Bore Femoral Central Catheter Line

Central Venous Catheters & Midline Catheter (non-central)

Central Venous Catheters & Midline Catheter (non-central)

PICC Line

PICC Line

PICC Line

A PICC Line is the most used and least intrusive method for obtaining Vascular Access through a central catheter 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 Axillary Central Venous Line

A Small Bore Axillary Central Venous Catheter Access Device is the next step for Vascular Access if clinically indicated or a PICC is 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 Central Venous Line

Small Bore Internal Jugular Central Venous Line

Small Bore Internal Jugular Central Venous Line

Small Bore Internal Jugular Central Venous Line

A Small Bore Internal Jugular Central Venous Catheter Access Device provides the next option, assuming all PICC and Small Bore Axillary Central Venous 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 Femoral Central Venous Line

A Small Bore Femoral Central Venous Catheter Access Device is one of the last options to obtaining Vascular Access using a Central Venous Line.  If all PICC, Small Bore Axillary Central Venous Line, and Small Bore Internal Jugular Central Venous Line indications are met, and such lines are not available or unsuccessful, then a Small Bore Femoral Central Venous Catheter Access Device 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 Axillary Central Venous Line

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 vascular access clinical nursing services at the bedside across the southeast to a diverse client base including hospitals, long term acute care centers, surgical and outpatient centers, skilled nursing facilities, and at-home care.

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Cary, NC 27519
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