Central lines

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Hi, I am having some confusion between central lines and PICC lines. When would you use a central line, and when would you use a PICC line? I'm also confused about the tunneled and not tunneled thing.

I know they are both for long term use, and doctors do central lines while some nurses can do PICC lines. I guess I'm just confused on the difference and why use one over the other?

Thanks for any and all help

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I found this to be helpful when I was wondering the same thing

https://allnurses.com/infusion-nursing-intravenous/diff-b-w-53966.html

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Specializes in Pedi.

With the kids I work with, PICCs are meant for shorter term use. We put in a PICC for a child who needs a few weeks of IV antibiotics or who needs fast central access to initiate chemotherapy. A central line is surgically inserted into the chest and meant for longer term therapy. I see central lines in infants with cancer as well as older children who will be undergoing stem cell transplant. Though, the most common central line I deal with is a port-a-cath.

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Specializes in Pediatrics, Emergency, Trauma.
I found this to be helpful when I was wondering the same thing

https://allnurses.com/infusion-nursing-intravenous/diff-b-w-53966.html

Great resource. :yes:

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Specializes in Pediatrics.
With the kids I work with, PICCs are meant for shorter term use. We put in a PICC for a child who needs a few weeks of IV antibiotics or who needs fast central access to initiate chemotherapy. A central line is surgically inserted into the chest and meant for longer term therapy. I see central lines in infants with cancer as well as older children who will be undergoing stem cell transplant. Though, the most common central line I deal with is a port-a-cath.

PICC lines are for long-term, not short term use. Central lines, such as IJs, are for short term use (usually a maximum of a few weeks). Port-a-caths are even longer term use, usually oncology patients or patients who are frequently hospitalized and have poor access.

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Specializes in ER trauma, ICU - trauma, neuro surgical.

The big factor between the two is right in the title. PICC's are peripherally inserted central line catheters while a central line is just a central line (usually in the femoral, subclavian, or jugular). PICC just means it was placed in the arm, therefore, peripherally. If you think about it, peripheral means in the extremities. Anything not in the extremity is considered central. They both end up in the same place (the superior vena cava or at the cavoatrial junction). Both can be used long term.

Tunneled describes the path to insertion. If it is tunneled, then the catheter is tunneled under the skin to the site (just like a tunnel leading to a cave...the entry point is different then the end point). Non-tunneled means the catheter enters the vein directly under the skin.

220px-Port-catheter.jpgThis is a tunneled Port. See where the port was inserted and the tube tunnels under the skin to the neck.

There are different reasons for a PICC vs CVL. Some PICCs have valves in them so they don't clog. PICCs are usually put it by IV team (sometimes in radiology), so it's more convenient for doctors to order a PICC and not have to insert a central line. Only docs and CRNA's can insert CVL's (basically). PICC's usually have two lumens (sometimes 3) so the catheter can be smaller and it's more more convenient. CVLs usually have 3-4 lumens, so the cath is bigger. You can give meds and blood faster in CVL's (if necessary). If a pt is really sick and on multiple IV drips, a two lumen PICC line is not enough. A 4 lumen CVL allows the nurse more access (since many drugs can not be mixed together). If you want a central venous pressure (CVP) aka right atrial pressure, a CVL is best. Yes, you can use a non-valved PICC for a CVP, but sometime you have to take that with a grain of salt. PICCs are longer, smaller, and can get sludge or crystalization over time. A nice, big, patent CVL is more accurate. And, when speaking in terms of infection, I think PICCs are a little more easily managed. I'm not gonna talk infection rates with studies but I will say this....Femoral CVL's have about 24 hrs before infections dramatically increase b/c it's located in the groin. Skin folds is the groin are not clean. If a groin CVL was put in, it's because it was an emergency and you are buying time for a PICC. Tegaderms on a neck CVL can sweat off, or have hair underneath them, or get kinked during turning. And forget trying to manage one with a c-collar on. A PICC dressing is away from everything and the tegaderm is usually always intact.

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Specializes in Pedi.
PICC lines are for long-term, not short term use. Central lines, such as IJs, are for short term use (usually a maximum of a few weeks). Port-a-caths are even longer term use, usually oncology patients or patients who are frequently hospitalized and have poor access.

I said in the kids I work with. Generally, we don't keep PICCs in for very long in children. I see PICCs in kids who need a few weeks of IV antibiotics or who need quick central access to initiate chemotherapy. Once their induction is complete, they get a more permanent line. We almost never use IJs in kids. The central lines they have- usually broviacs- can stay in for years. I have many kids who've had their broviacs for a year or longer. I have no kids who've had PICCs for that long.

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Specializes in NICU, PICU, PACU.

Our PICCs are placed either by our fellows or NPs, if they can't get one in on the 3rd attempt then Interventional Radiology is called and they put in a Femoral PICC. We try to not leave our PICCs, especially the fem ones, in for longer than 60 days as most of the time our kids grow and the lines end up out of position and the fem ones are an infection nightmare. For our long term kids such as congenital issues, gut kids or kids we just can't get a peripheral PICC in, they go down for Broviacs.

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Specializes in Hospital Education Coordinator.

PICC's are central lines, but inserted peripherally. Tunneled means the tubing is under the skin to help prevent infection.

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Tunneled Central lines or ports for long term therapy are best.

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Specializes in Infusion Nursing, Home Health Infusion.

There are several ways to classify Central lines. First be aware that central lines have a tip that resides in a central vein optimally in the low SVC/cavoatrial junction. So if is is central line it must have its tip in a specific anatomical location. Hemodialysis catheters also should have their distal tip in the RA. Next you can refer to them by their function.type and anatomical location or point of insertion. A non-tunneled central line is has an insertion point close to the vein. There is a short skin tract which is from the skin entry point. Tunneled catheters are placed under the skin and through the subcutaneous tissue to the site needing access.

As far as the CVP monitoring from PICCs..there is nothing to indicate that this is not an accurate measurment. See this article:

Comparison of the central venous pressure from internal jugular vein and the pressure measured from the peripherally inserted antecubital central catheter (PICCP) in liver transplantation recipients

The majority of central lines that we have in our ICUs are the triple lumen power PICCS because not only can we get a CVP we can leave them in for long periods of time due to their decreased infection risk.

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