IV lines

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I'm currently on my second week of orientation on a medical surgical ICU. I feel so overwhelmed, especially about the multiple lines running. I know this may seem like a dumb question, but how do you recognize a CVP or a PA line? I'm always confused about which port to use.

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No question is ever a dumb question. The CVP sits in the right atria. If we are using a central line, we use the distal port to obtain a reading. Sometimes this is colored blue on the monitor or the pressure tubing. The waveform looks similar to artifact - average pressure is 0-6mm Hg (but is really dependent on patient condition and situation)

The PA port is typically seen in a Swan Ganz catheter. The tip lies in the pulmonary artery. If you have a Swan, typically the blue port = CVP, yellow =PA, white= VIP or venous infusion port and red= balloon.

The waveform of the PA line can tell you fluid status, placement of catheter, physiologic abnomalities, and a few other things.

The two ports that should never have meds/fluids infusing are the balloon and the PA. You can draw blood off of the yellow for a mixed venous ABG.

Hope this helps.

Moonshadeau

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On a tripple lumen central line, which would be the CVP, which would you use to infuse meds through? You're never supposed to infuse drips through a CVP, right? Only maintance or IV antibiotics? I seem to understand the theory behind the lines but which line to infuse meds, using the stop cocks, drawing blood is really confusing. Can you graw blood from a CVP?

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Specializes in Cardiac.

Of course you can draw blood from a CVP port. And you can hang meds into it as well. Why not?

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On a tripple lumen central line, which would be the CVP, which would you use to infuse meds through? You're never supposed to infuse drips through a CVP, right? Only maintance or IV antibiotics? I seem to understand the theory behind the lines but which line to infuse meds, using the stop cocks, drawing blood is really confusing. Can you graw blood from a CVP?

What I think that you need to separate is that the central line ports on a triple lumen can all be infused into. A CVP is a measurement that comes from the distal port. A central line is the method in which you check a CVP. You can have a central line in and not check a CVP.

You can check a CVP continuously by hooking it up to pressure tubing and then leaving it alone. (And you can draw blood from this). You can check a CVP intermittantly if you connect a three way stopcock at the port end. If you turn the CVP off, you can run fluids. If we have to check intermittantly because we are running out of lines, we usually check hourly what our values are.

You can do both at the same time, but your values will likely to be false.

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Thankyou, Moonshadeau, It's getting clearer. So with the stopcocks, before an infusion, I'm turning off the CVP measuring, and infusing fluids. And I guess the same thing when you draw blood. My preceptor said that you'd never put any of the drips such as dopamine or nitro on a CVP line. Only maintanance or antibiotics, is that because of the flow rate? Or is it because you want to keep a dedicated line free?

My other question is, visually how do you recognize a PA line/swan catheter versus a multi lumen central line? Do the ports look different? You said that the Swan has:

"If you have a Swan, typically the blue port = CVP, yellow =PA, white= VIP or venous infusion port and red= balloon"

Is that the best way to remember them then, or can a central line have the same colors too? Or does it matter, if I'm looking for a line to blood or push meds? So long as I stay away from the yellow and the red?

Again, Thank you so much for your help.I have never felt more incompetent in my life. I have a great preceptor, but she can't understand why I'm having such a trouble understanding all the lines.

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thankyou, moonshadeau, it's getting clearer. so with the stopcocks, before an infusion, i'm turning off the cvp measuring, and infusing fluids. and i guess the same thing when you draw blood. my preceptor said that you'd never put any of the drips such as dopamine or nitro on a cvp line. only maintanance or antibiotics, is that because of the flow rate? or is it because you want to keep a dedicated line free?

your preceptor is correct. the meds that you mentioned are most likely very crucial to the hemodynamic stability of the patient. however, if you put antibiotics or a maintenance iv through the cvp, you would not see the drastic consequence that you would if you stopped the vasopressors

my other question is, visually how do you recognize a pa line/swan catheter versus a multi lumen central line? do the ports look different? you said that the swan has:

if you see a long line coming out of the patient, it is probably a swan. these catheters are about 150cm from tip to end of the ports. typical length in a patient is about 45-60 to be in the pa.

"if you have a swan, typically the blue port = cvp, yellow =pa, white= vip or venous infusion port and red= balloon"

is that the best way to remember them then, or can a central line have the same colors too?

what i listed previously are swan ganz color markings. triple lumen catheters are typically brown (distal/cvp), blue (proximal) and grey (medial).

or does it matter, if i'm looking for a line to blood or push meds? so long as i stay away from the yellow and the red?

you can only draw blood and measure intra-arterial pressures on an a-line. you cannot push meds through this line.

i am going to reccommend that you visit these two websites to help give you some visual references to what i am talking about and to help cement the theory to the clinical. if your preceptor hasn't shown you a swan-ganz catheter, an arterial line, and a triple lumen central line, they need to asap.

www.icufaqs.org

www.pacep.org

feel free to pm me at any time for further questions.:D

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Specializes in NICU, PICU, PCVICU and peds oncology.

You'll be able to tell the lines apart because they look different. See the photos attached. The first one is a pulmonary artery catheter. It has several lumens, and the longest one one has a sleeve on it and a number of other ports. This is the line used for pulmonary wedge pressure measurements. The shortest pigtail is to the balloon. The red port is the pulmonary artery pressure lumen. Handle this with extreme care because if it slips in farther than intended it will "wedge" and infarct the lung. The others are essentially a central venous line. Look at the flange. There are two other lumens coming from it. They can be used for infusions. The second photo has both a double and a triple lumen central venous line in it. Notice the difference in appearance? When you have a patient with a PA catheter ask your preceptor to give you a "tour". The reason you don't want to run drugs like dopamine into your CVP is that you might have to push fluids through that port and you don't want to push vasoactive infusions. But for fluid boluses, blood transfusions, antibiotics and other intermittent infusions, you're good to go.

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Thankyou, Janfrn and Moonshadeau, You guys are great. I understand now. Moonshadeau, I read the articles on central lines and PA lines on the ICUFAQ web site. But I was having a difficult time recognizing them on a patient. I knew theoretically(well kind off!) what they did but I couldn't figure out which was which because of the stopcocks and the number of connectors. I think it'll be a lot easier for me to look at them and understand what they are.

Thanks again so much!

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Specializes in Cardiac.
My preceptor said that you'd never put any of the drips such as dopamine or nitro on a CVP line. Only maintanance or antibiotics, is that because of the flow rate? Or is it because you want to keep a dedicated line free?

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The only reason to not use the CVP line is that when you fast flush/zero out the line the pt gets a bolus of whatever is in the line. That's why your preceptor says Abx or MIVs are safe to use on that port.

Otherwise, you can most definitely infuse through that port. Without the pressure tubing, it's just another port on the TLC.

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Thank you for replying, this is such a great forum for learning as well as emotional support

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