Lines-Please help

[raspberry1]

Hi guys,

Can someone please explain the difference between a regular peripheral line, a PICC line, central line and midline? I'm having a difficult time grasping which is which and what each is used for

Thanks in advance

[dudette10, MSN, RN]

All of this information can be found by googling and choosing reputable sites.

[brownbook]

All of this information can be found by googling and choosing reputable sites.

You're brilliant. Before you replied I spent, wasted, about 20 minutes trying to compose an answer and barely covered the basics. I fnally gave up.

[NICU Guy, BSN, RN]

A PICC is inserted in a peripheral vein in the arm (in NICU-head, leg, foot), such as the cephalic vein, basilic vein or brachial vein, and then advanced proximally toward the heart through increasingly larger veins, until the tip rests in the distal superior vena cava or cavoatrial junction. It can be used for a prolonged period of time (e.g., for long chemotherapy regimens, extended antibiotic therapy, or total parenteral nutrition) or for administration of substances that should not be done peripherally.

A midline (EPIV-Extended Peripheral IV) is inserted the same as a PICC except that it rests short of the distal superior vena cava. Since it rests in the larger veins, it can be used for the same uses as a PICC.

Peripheral IV- short IVs that go into a peripheral vein for IV access.

[dudette10, MSN, RN]

You're brilliant. Before you replied I spent, wasted, about 20 minutes trying to compose an answer and barely covered the basics. I fnally gave up.

Ha! I'm an instructor now, and preventing learned helplessness is one of my priorities!

[brownbook]

Ha! I'm an instructor now, and preventing learned helplessness is one of my priorities!

That sounds like what I need to "prevent" with my husband! The other day I asked him to load the dishwasher. He said he didn't know how to load a dishwasher!

[EllaBella1, BSN]

^^What he said.

But to add: A PICC is a type of central line, but what is more commonly referred to as a central line is slightly different. A central line, usually internal jugular, subclavian, or femoral, is a central line with the tip in the SVC, but it's inserted directly into a larger vein, as opposed to insertion in a peripheral vein and advancing to the larger veins and then the SVC.

And when it comes to midlines, you can't always use them for the same things central lines are used for, so be careful with that. It's pretty hospital policy-specific. At my hospital you can't use it for pressors, TPN, etc.

[Here.I.Stand, BSN, RN]

Some meds are highly irritating to veins. Should those be infused into a little bitty vein in the hand... or would a large vein with rapid bloodflow be better for those meds?

Some meds can even cause tissue necrosis if they get into the extravascular areas. Which type of line can infiltrate? Will that type of line be appropriate for those meds?

Some people need longer-term IV meds, such as those with cancer or osteomyelitis. Or like a friend of mine whose hyperemesis gravidarum was so severe she needed to give herself IV fluids at home. Which type of line is both durable, doesn't need q 1 hr assessment, and appropriate/comfortable for home use?

Some people have difficult vasculature to stick -- their veins tend to blow, they are difficult to see or palpate, or visible veins are tiny and squiggly. They may need IV therapy for a few weeks, but only things like fluids and Zosyn -- nothing that needs to be given centrally. What type of line is a peripheral line, but more durable than a bitty 1-2 inch PIV?

Another pt needs those same meds, but they have veins you could hit with darts! -- or at least that show themselves nicely with a tourniquet and a warm blanket wrapped around the arm. What type would meet their needs but not be overly invasive?

[OldDude]

That sounds like what I need to "prevent" with my husband! The other day I asked him to load the dishwasher. He said he didn't know how to load a dishwasher!

He doesn't know how or he doesn't know how YOU want it to be loaded?

[CelticGoddess, BSN, RN]

^^What he said.

But to add: A PICC is a type of central line, but what is more commonly referred to as a central line is slightly different. A central line, usually internal jugular, subclavian, or femoral, is a central line with the tip in the SVC, but it's inserted directly into a larger vein, as opposed to insertion in a peripheral vein and advancing to the larger veins and then the SVC.

And when it comes to midlines, you can't always use them for the same things central lines are used for, so be careful with that. It's pretty hospital policy-specific. At my hospital you can't use it for pressors, TPN, etc.

When I worked Onc, most chemo meds couldn't go through midlines. If it couldn't go through a peripheral, it couldn't go through a midline. We pretty much only used midlines for longer term IV antibiotics. For the most part, the oncologists would have a port placed before starting chemo.

[brownbook]

He doesn't know how or he doesn't know how YOU want it to be loaded?

Okay, that's fair. Ha ha. He loaded them as badly backwards as person could. I smiled, said thanks, and reloaded it in the morning.

Next time I said you're right, you're a better rinser, I'm a better loader. He managed to find things to complain about. He's just a GOM.