A-lines vs. Central Venous lines

[zlatamoya]

I'm a new grad who is also new to the SICU...I know this sounds lame but I'm having some probs figuring out the differences about central lines. What exactly is different about an A-line verses a CV-line? Why is the subclavian the preferred site? Why would a doc choose to put in one vs. the other? I feel cheesy that I don't get this yet..but I'd rather ASK! Thanks in advance!

[ukstudent]

An A-line stands for arterial. The most common site is the radial artery. This gives you a constant ability to monitor the pt's BP. You do not give meds though this line.

A CV-line stands for central venous. The most obvious difference is that this is a venous line. Site preference depends on what the doc's preference is. Internal jugular and subclavian are more common than femoral. With a central you can monitor the central venous pressure (CVP), give large volume's and give vasoactive meds.

[XB9S, BSN, MSN, EdD, RN, APN]

I was going to answer but I see UKstudent has beaten me to it and given a brilliant explanation.

Wikipedias definitions.

wiki definition A line

wiki definition CVC

[pietr422]

Doctors will often choose the IJ site over subclavian (for central venous lines) when patients have coagulopathy issues. It was explained to me that in the presence of bleeding, it is much easier to oclude the IJ than the SC or Femoral sites.

-AP

[JeffTheRN]

One of the doctors on my unit also explained to me that fem lines have to come out after a few days as well, so we rarely see a fem insertion.

[Dinith88]

Why is the subclavian the preferred site? !

2 big reasons why IJ/SC sites are preferred over groin sites...

1) a patient usually cannot ambulate with groin line (risk of bleeding, etc.)

2) Just like mom used to say..' the groin is a dirty place' (higher risk of infections)

which is why they haveto come out sooner (like someone else said)

Apparently these reasons outweigh the fact that groin insertions are far less risky (they're more readily compressable(sp?) if bleeding developes (nicked artery/etc.), and you can't drop a lung (pneumothorax))

[BillboSN]

The IJ (internal jugular) is preferred over the SC (subclavian) for a central venous catheter because you get a more accurate central venous pressure with the IJ. Correct me if I am wrong, but that is what I was taught.

[Dinith88]

The IJ (internal jugular) is preferred over the SC (subclavian) for a central venous catheter because you get a more accurate central venous pressure with the IJ. Correct me if I am wrong, but that is what I was taught.

No. it all depends on where the tip of the catheter sits (SVC/RA) rather than where it's inserted.

[delta32]

here is a great site for new ICU nurses:

http://icufaqs.org/

it has everything very simple and easy to grasp

HTH

jamie

p.s another idea is a book called Critical Care made incrediably easy

[Dinith88]

Doctors will often choose the IJ site over subclavian (for central venous lines) when patients have coagulopathy issues. It was explained to me that in the presence of bleeding, it is much easier to oclude the IJ than the SC or Femoral sites.

-AP

Whoever explained that to you was wrong. You can clamp down HARD on a groin...not so on someone's neck (for many reasons). Think about it...would it be easier to control an inadvertant puncture of a carotid artery or a nicked femoral artery? With coag issues to boot??

If i were you I would re-visit this with your instructor/mentor/whoever.

[pietr422]

Thanks Dinith88. I agree with you when comparing IJ vs. Femoral. I was comparing IJ to SC, in which case the IJ site would be easier to compress than the sc. I believe that the subclavian vein is difficult to compress when compared to IJ.

[Dinith88]

Thanks Dinith88. I agree with you when comparing IJ vs. Femoral. I was comparing IJ to SC, in which case the IJ site would be easier to compress than the sc. I believe that the subclavian vein is difficult to compress when compared to IJ.

OK gotcha...your initial post stated otherwise...so iresponded to that typo.