Central lines v PICCs

[Catherine Mackey]

Hi all, 

please don’t judge me by asking this questions but. I need to know if PICC lines can be treated the same was a central line. PICC obviously stands for peripherally inserted central catheter, but for the purposes of medications such as IV potassium there are specific rates only to be done through a central line. Because it is inserted peripherally, do you still treat it that way? 

please refrain from any judge mental comments! Just trying to be the best nurse I can be! 

thanks

[Tweety, BSN, RN]

Yes a PICC can be treated just like a central line as far as rates of potassium and other medications.  Both subclavian central lines and PICC lines go into the same place in or near the subclavian vein, one is just placed lower in the body.  

[AceOfHearts<3]

A PICC line IS a central line, so yes- anything can be run through it and at rates and concentrations of other central lines. If you ever get a chance to see how long the catheter is (like when one is being removed), it will make sense. In the ICU if a patient didn’t have positive blood cultures and long term central access was needed we would have a PICC placed. A lot of times we’d have an IJ CVC or maybe femoral depending on how emergent placement was and then change it over to a PICC as soon as we could based on the patients status. 

[JBMmom, MSN, NP]

No judgment intended, but if you're using PICC lines and central lines for medication administration and blood draws, your educator should be providing guidance if they're new to you. Glad you're doing this research, but different hospitals may have different policies related to these lines, so you should be educated on your hospital specific policies. Good luck!

[DavidFR, BSN, MSN, RN]

The only judgement I will make is that you're a very smart, conscientious nurse to ask a question when you're not sure.

We're all inexperienced with something until we experience it. No shame in not knowing.

I agree with the above posters - treat it like a central line.

[Daisy4RN]

As others have stated a PICC is a central line and can be used as such depending on your P/P. You need to make sure the placement is correct, documented (xray), and you have a MD order to use it. Also, just know that at times the line may actually be a midline but people still call it a PICC when they should not be. If it is being used as a PIV or a midline then you cannot use it for vesicants etc. Always check first in the chart.

[2BS Nurse, BSN]

There must be a good Youtube video that explains these! I watched a nurse insert PICCs all over the hospital once. She was amazing!

[SansNom]

I started inserting PICCs last year, and I've been surprised how many nurses really don't understand the difference in various vascular access devices. Frankly, a lot of it is just semantics and how we use certain terms. For example: in the hospital we often make the differentiation between a "central line" and a PICC, although they are both technically central lines. One is just inserted peripherally.

So quick rundown: all central lines (including dialysis catheters and implanted chest ports) terminate in the superior vena cava or cavoatrial junction, except femoral lines (see below). Even Swan-Ganz catheters can be pulled back to be used as a central line so that the tip is positioned lay in the SVC or cavoatrial space. The term "central" is essentially referring to where the tip is lying. The term "central line" is usually specifically used to refer to shorter lines that are inserted in the internal jugular, subclavian, or femoral veins. These are higher risk for CLABSI and can't usually stay in as long, but can be inserted faster and are usually used for emergent central access. A PICC is inserted in the basilic, brachial, or cephalic vein of the upper arm. They can stay in indefinitely (depending on facility policy), are lower risk for CLABSI than other central lines because of their length from access site to tip location, and take 30-40 minutes typically to put in, so they're usually non-emergent. Technically they are all central lines because they all terminate in the SVC or cavoatrial junction (or inferior vena cava in the case of the femoral line), and you will treat them the same way as far as flushing and care.

Oh, and let's not forget about Midlines. These can look like single lumen PICCS because we insert them in the same upper arm veins, but their tip does not terminate centrally. They're usually 10-15cm long and terminate around the axillary. I see nurses mix these up a lot too. They can only be used as a normal peripheral IV, except that some facilities allow blood draws from them. They can also last up to 30 days (depending on facility policy). Avoid vesicants in these because extravasation would be hard to spot until a lot of damage had been done because they're deeper.

All of these lines need dressing changes once a week and PRN.

Hope that helps a little. It's a good question more nurses need to ask or look up.