Can U Explain the difference? pleeease??

piccs end in the superior vena cava (svc).

midlines end in the axillary vein (just at or the shoulde or just short of the shoulder).

they can be the same catheter, but the internal length of a midlie is much less. (the amount inside the patient).

most midlines will probably be 10-15 cm (from memory; i don't place midlines anymore); while piccs generally run from 35-50cm, depending on where on the arm they start and how tall the patient is.

when i used to place midlines, i would use a regular picc cathter cut to the appropriate length (all of our picc catheters are trimmed), so it can be impossible to tell which it is from the outside.

if your hospital doesn't use catheters that can be trimmed, then you will notice more "external" length coiled on the outside of the arm for midlines.

if you are not sure, and can't find the documentation, get a cxr.

i alway posted a sign on the chart and one over the bed clearly stating that the catheter was a midline, not centrally placed.

the confusion is the main reason i don't placed midlines anymore. i found tpn infusing through one once, because the type of line hadn't been clearly communicated when the patient went from icu to the floor bed. "looks like a picc....must be a picc" is a bad assumption, but one i found often.

(they do make specific midline catheters, too, that say "midline" on the hub. my hospital just doesn't use them.)

didn't see the second question.

a cordis is a brand of sheath introducer -- used to introduce something else into the venous system -- such as a temporary transvenous pacemaker, or a pulmonary artery catheter.

it is a very large bore central line, and will ususally have a side port that medication can be infused through.

sometimes, it is used by itself, without any device being put through it, for high-volume fluid/blood resusucitation.

this explination doesn't seem to be very clear. i'll see if i can find a picture.

here is the picture. kind of hard to see, but the pacer or pa catheter goes through the white end on the right of the picture.

TruamaGirl, you may hear the word introducer instead of cordis at times, I think cordis is a name brand possibly? Like we use Arrow introducers. Maybe someone else can update you alittle better..

Sorry CritterLover, did'nt see your last response to the term of cordis...

thanks so much for the info on this stuff! It really helped!

What about a Quinton Cath? Where does it end up? And a generic central line?

Occasionally, a peripheral IV is started in an artery instead of a vein (by mistake, of course). When that happens, especially on a critical patient, why can't we give medication through it before discontinuing it?

Is a Quinton cath used for dialysis, I think? I'm totally scared of dialysis caths - mostly because in nursing school, all you're taught is "Don't touch them!". What's the big deal? Is it because they have heparin in them, and they can clot easily, or is there something else I should know?

These are great questions - I'm interested in the answers. People toss these terms around all the time, but I suspect that many (including myself) don't know the differences between them, and it's very difficult to get someone to explain them. For some reason, much of the literature gives poor explainations. And I think that's ridiculous - if we're using them, we should know them back and forth!

what about a quinton cath? where does it end up? and a generic central line?

occasionally, a peripheral iv is started in an artery instead of a vein (by mistake, of course). when that happens, especially on a critical patient, why can't we give medication through it before discontinuing it?

medications can't be given into an arterial line because they (meds) can cause the artery to spasm. major tissue damage can occur. (this is especially true of the pulmonary artery. never give meds through the pulmonary artery port of a pa catheter).

i once saw a patient who had a line inadvertently started in the radial artery. demerol was given. patient lost his hand.

edited to answer the other part of the question:

any kind of central line should have its distal tip in one of three locations: the svc, inverior vena cava (ivc), or right atrium of the heart. if the tip stops short of there (say, the brachiocephalic vein [also called the "inominate vein"]), it is not technically a central line.

(ra as a location is a little controversial except for hd catheters. it is generally an accepted location for hd cathters.)

so in general, central lines that start in the upper body (ij, subclavian), end in the svc or right atrium. central lines that start in the lower part of the body (fem lines) end in the ivc.

i did a whole inservice on this stuff. if anyone wants to look at it, and has power point, send me a pm and i'll send it to you.

medications can't be given into an arterial line because they (meds) can cause the artery to spasm. major tissue damage can occur. (this is especially true of the pulmonary artery. never give meds through the pulmonary artery port of a pa catheter).

i once saw a patient who had a line inadvertently started in the radial artery. demerol was given. patient lost his hand.

thank you, thank you, thank you!!!! you are the first that has been able to answer this question for me!

is a quinton cath used for dialysis, i think? i'm totally scared of dialysis caths - mostly because in nursing school, all you're taught is "don't touch them!". what's the big deal? is it because they have heparin in them, and they can clot easily, or is there something else i should know?

these are great questions - i'm interested in the answers. people toss these terms around all the time, but i suspect that many (including myself) don't know the differences between them, and it's very difficult to get someone to explain them. for some reason, much of the literature gives poor explainations. and i think that's ridiculous - if we're using them, we should know them back and forth!

quinton makes a type of hd catheter, but so do other companies. i think they make permcaths, which is a type of long-term hemodialysis catheter. vas cath is a name of common temporary hd catheter.

most facilities don't want you using the hd catheters for routine vascular access becasue the hd catheter is the patient's lifeline. hd catheters have to be able to tolerate very high flow rates. if it clots off or becomes infected, the patient may not be able to go to dialysis. the more people that use the hd catheter, the more likely it is that problems may occur.

the heparin is a concern, too. hd catheters are usually packed with failry concentrated heparin. i've never done dialysis, so i'm not sure what heparin concentrations are common, but more concentrated than heplock (i was once told it was the 5000 u/cc, but i don't know if that is correct). while heplock can be just flushed through the catheter and into the patient, the heparin in hd catheters has to be withdrawn before use. otherwise, the patient gets bolused with the heparin every time the line is flushed. plus, the line has to be re-packed with the correct amount of heparin after use.

some facilities will allow bedside nurses to use the hd catheter if the nephrologist oks it. others strictly forbid it, except in an emergency.

Critter....

I just wanted to say that you're amazing. I hope I know 1/4 of the stuff you do someday.

Blessings,

Crystal

So, is a Quinton cath only venous access? Or is like a regular AV shunt that's used for HD?