central line, hickmann line, and pulmonary catheter ??

Daytonite, BSN, RN · Mar 11, 2009

you will also find entries for these in taber's cyclopedic medical dictionary. i was an iv therapist for many years and dealt with these access devices. they are all central iv lines but have their special uses. you will also find information about them on post #5 of this sticky thread: https://allnurses.com/nursing-student-assistance/any-good-iv-127657.html - any good iv therapy or nursing procedure web sites. there are complications associated with the care and use of these lines that you need to be aware of and all that information can be found in the weblinks on those postings. there is a tutorial on the pulmonary catheter: http://www.pacep.org/ - pacep; pulmonary artery catheter tutorial. websites on hemodynamic monitoring (which is what is done with pulmonary catheters) is listed on post #39 of the same thread.

central line - this is an iv catheter that is inserted into the mid section of the body. the common sites of entry that are used are the subclavian vein, the external jugular vein or the femoral artery. for p.i.c.c.s (peripherally inserted central catheters) the basilic vein in the forearm may be used. the distal (ending) tip of the catheter may terminate in the subclavian vein, but more commonly is threaded into the superior vena cava of the heart and this is confirmed by an x-ray. the advantage of these lines is that placement in the superior vena cava allows for instantaneous hemodilution of even the most irritating of iv fluids the moment the solution enters the turbulence of the right atria of the heart.

hickman line - this is a tunneled type of central line. it is inserted and intended to remain in place for 6 months or longer. its forerunner was the broviac catheter which was a smaller lumen iv catheter that was developed for use in pediatric patients needing long term iv access. hickman lines that i saw were tunneled under the skin of the front of the chest. we had repair kits so that if the catheter happened to break off (some of these patients could be really rough with them in their daily lives) we could repair them. the patients getting this kind of catheter are on long term tpn, chemotherapy, antibiotics or blood transfusions and either have exhausted peripheral veins or the stuff they are getting is too irritating to put through a peripheral vein.

pulmonary catheter - this is a very specialized central line used in the cardiac care units. you will hear it referred to as a swan-ganz line. it is longer than the regular central line and when it is inserted it is threaded beyond the superior vena cava and placed directly into the pulmonary artery. refer to an anatomy diagram of the circulation through the heart if you need to refresh your memory on this pathway. once in the pulmonary artery, the catheter has a small balloon at its distal tip where the nurses can inflate it allowing the balloon to drift and wedge into a pulmonary capillary and record periodic pulmonary artery wedge pressures (pawp). the catheter has multiple lumens and temporary pacemaker leads can also be inserted through it and attached to a temporary pacemaker for heart pacing. you will only see these in an intensive care unit. before the patient is moved out of the ccu or icu the tip of the catheter will be pulled back to the superior vena cava.

iluvivt, BSN, RN · Mar 12, 2009

just wanted to add the current recommendation is to have the tip of any CVC in the Low SVC (superior vena cava) and preferably at the cavoatrial junction. Sometimes this is not always possible due to pathophysiologic reasons but an effort needs to be made as every complication is more likely. For example,CVCs outside of the SVC are 8 x more likely to develop a thrombosis. Fem lines are of course,in the IVC.

coffeekat · Mar 17, 2009

thank you all for the detailed information