Peripheral Vasopressor Administration - Considering Catheter Gauge

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by 0.9%NormalSarah 0.9%NormalSarah, ADN, RN Member

Specializes in ICU. Has 3 years experience.

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offlabel

offlabel

1,440 Posts

On 1/30/2022 at 6:40 AM, Wuzzie said:

We have a lot of new grads who may not be familiar with central lines and this site strives to provide them accurate information. They may not be aware that for a line to be called a “central line” it doesn’t matter where it’s inserted it only matters that it terminates in the central circulation. Given that this is a discussion of appropriate lines for the administration of vasopressors being clear about the types of line is important. 
 

The clap back wasn’t necessary. 

"Central Line" and "PICC" are different terms to be understood differently. They are cared for differently, the safety considerations are different and they have vastly different use capabilities. Something every trainee should understand very well before using. That the two share the term 'central line' does not remotely mean they're the same thing. 

Wuzzie

4,864 Posts

23 minutes ago, offlabel said:

That the two share the term 'central line' does not remotely mean they're the same thing. 

Never said they were. But a PICC line is still a central line and has vastly different uses, safety considerations and care than a PIV. Something that a trainee should understand very well before using.

Edited by Wuzzie

MaxAttack, BSN, RN

Specializes in Trauma/surgical/neuro critical care. Has 7 years experience. 405 Posts

@Wuzzie Yes it was petty. The post seemed pretty clear and if someone has a question they can ask.

That being said, my only issue with running pressors through PIVs is that the studies done on them were done with staff training and protocols in place with specific requirements and normally meds built in (eg phentolamine) in case of extravasation.

I've had more than one doc say peripheral pressors are "evidence based" without considering that side of it.

Where I'm at pressors are ran through a PIV just as a temporary stopgap. Overnight with an order for a PICC in the morning is OK if they just need a little low dose bump. If we're getting into full-on resus then a central line (of any type) is going in then and there.

Wuzzie

4,864 Posts

1 hour ago, MaxAttack said:

The post seemed pretty clear and if someone has a question they can ask.

Not if they don’t know what to ask. Like I said, we have students here…a lot of them. All I did was clarify. It wasn’t petty in the least. I didn’t call anyone out, I didn’t call anyone stupid I just pointed out a simple fact that some people may not be aware of. It’s unfortunate that it can’t be left at that. A small teaching moment in a thread meant to be educational has been turned into something nefarious and now I’m being accused of being petty by strangers on the internet who seem to think they know my motivation better than I do. ?

MunoRN, RN

Specializes in Critical Care. Has 10 years experience. 8,058 Posts

On 1/31/2022 at 9:39 AM, offlabel said:

"Central Line" and "PICC" are different terms to be understood differently. They are cared for differently, the safety considerations are different and they have vastly different use capabilities. Something every trainee should understand very well before using. That the two share the term 'central line' does not remotely mean they're the same thing. 

What primarily defines the "use capabilities" are where the tip is, which is why we define the type of line on were the tip is (any line with a centrally located tip is considered "central").  Where the line starts isn't all that pertinent actually (basillic, cephallic, IJ, femoral).  

MunoRN, RN

Specializes in Critical Care. Has 10 years experience. 8,058 Posts

Back to the original question; the gauge of IV doesn't actually predict the reliability of the site and/or line.  There are studies that show smaller gauge IVs are less reliable, but thats because we're more likely to place a smaller gauge IV in a more sketchy site, to evaluate whether smaller gauges are less reliable given the same site would require a study controlled for site and IV gauge, of which there are none.

The important thing consider is what is meant by recommending that pressors be run through a large vein.  The key is that pressors immediately infuse into a significant venous flow.  A large bore IV placed in a smaller vein contradicts this premise, versus a smaller bore IV placed in the same vein complies with this premise far better.

offlabel

offlabel

1,440 Posts

On 2/6/2022 at 10:30 PM, MunoRN said:

What primarily defines the "use capabilities" are where the tip is, which is why we define the type of line on were the tip is (any line with a centrally located tip is considered "central").  Where the line starts isn't all that pertinent actually (basillic, cephallic, IJ, femoral).  

Never heard of nor seen a VAE via a PICC. Can't say the same about an actual central line. Never measured a CVP via a PICC either. To say that the length of a catheter isn't pertinent  makes no sense at all. And to say that "use" is the only consideration for any invasive device doesn't either. 

MaxAttack, BSN, RN

Specializes in Trauma/surgical/neuro critical care. Has 7 years experience. 405 Posts

On 2/8/2022 at 10:17 PM, offlabel said:

Never measured a CVP via a PICC either.

There's been a few studies that have shown that CVP can be measured accurately from PICC lines. I've only seen it in practice maybe once. Now whether or not CVP is useful for anything besides a pretty waveform and number is an entirely different story ?. I die a little inside every time I hear someone mention CVP and fluid responsiveness in the same sentence.

Edited by MaxAttack

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offlabel

1,440 Posts

1 hour ago, MaxAttack said:

There's been a few studies that have shown that CVP can be measured accurately from PICC lines. I've only seen it in practice maybe once. Now whether or not CVP is useful for anything besides a pretty waveform and number is an entirely different story ?. I die a little inside every time I hear someone mention CVP and fluid responsiveness in the same sentence.

It is true that many people are ignorant about the role of CVP (right atrial pressure, really) and it's affect on venous return, downstream LV filling, cardiac output and ultimately, blood pressure.

 Right atrial pressure is a valuable indicator of cardiac performance in the absence of echo, to wit, further investigation is required if CVP/RAP and MAP are approaching each other, especially during volume administration. 

It's a metric that is used frequently in cardiac surgery. But I get it...when all you have is a hammer, everything looks like a nail.....

eileendg1989

eileendg1989, RN

Specializes in Emergency Room. Has 7 years experience. 18 Posts

Yes but a central line is usually done by the doctor and through the chest wall to SVC and picc are peripherally inserted.

offlabel

offlabel

1,440 Posts

On 1/31/2022 at 10:42 AM, Wuzzie said:

Never said they were. But a PICC line is still a central line and has vastly different uses, safety considerations and care than a PIV. Something that a trainee should understand very well before using.

When did we change the conversation to include PIV's?

Wuzzie

4,864 Posts

5 minutes ago, offlabel said:

When did we change the conversation to include PIV's?

Well, that’s the title of the thread soooo. 🤷🏼‍♀️