PICCs, CIVs, PIVs ???

[Bekahlynn]

On the unit where I work, we use all of these lines. Can somebody give me a quick, down and dirty explanation of the differences between them? And is there any particular reason that some CIVs are in the fem, some are in the IJ, and some are subclavian? Any explanations would be helpful. Thanks in advance!!!

[geekgolightly, BSN, RN]

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i'd like to know as well who some centrals are IJ and some are sub clavian

[eak16]

Can't answer the CIV questions, but I can tell you that PICCs are peripherally inserted central catheters, they are usually inserted in the upper arm and the line stays in the vein all the way to the caval-atrial junction. Because there is so much line inside the vein, the main risks are migration (tip of line moving into another vein, usually in the neck), thrombus formation, infection, and rupture (usually from a nurse forcing fluid through it when it is occluded). They can stay in anywhere from a couple days to a year or so- a year is the longest I have heard of them being in, and that was with a very compliant home-infusion patient. It has been my experience in my short career as a nurse that in a month or so most PICCs get occluded or infected and have to be pulled.

PIV I'm assuming stands for peripheral IV.

[CritterLover, BSN, RN]

The location of a central line is up to whomever is placing it. Fem lines seem to be the easiest, least "dangerous" place to put a central line. In my part of the country, it seems to be where the line gets placed by most ER docs, most medicine docs, and during codes. However, they are much more prone to infection than a central line placed in the neck/subclavian. IJ seems to be the location of choice for most anesthesia people. My understanding is that there is less risk of a pneumo when placed here versus subclavian. However, these lines tend to be positional and a little difficult to secure. As a nurse, I like the subclavian lines the best, they are easy to secure and tend to function the best, but they are riskier to place. I've noticed mostly surgeons and pulmonary/cardiac docs place these, though they seem to do alot of IJs, too.

[Aneroo, LPN]

Agree...

PIV= Peripheral IV

CIV= assuming it is the same as a central venous line...Most I've seen were IJ's or subclavians, depending on situation when it was inserted

PICC= peripherally inserted central cath...goes in AC or brachial to the SVC. I don't care for there as much...The patient can lie on it funny and it will still be occluded, still have to do sterile changes on it...

Oh well-Andrea

[Quincke]

IJs are often used by anesthesia as well as many MDs. The main risk here is hitting the carotid. Can usually be controlled unless the dilator is inserted into the carotid which usually means that pt needs to get to the OR ASAP. SC lines are my favorite as they seem to be the most stable and easily secured for a longer period of time, but there is a risk of pneumo b/c the lungs are right there. SCs are also good with volume depleted pts. Femoral are the ones I see least placed because of infection control (hard to keep this site clean and dressing dry on many pts) unless an emergency. Where I have seen PICCs used most is on pts who need a longer central access site (pts with needs for longterm antibiotics, etc.). Most CVLs are removed after 2 wks from what I have seen if not before that. PICCS can stay in for much longer. Central access is needed for certain drugs that are given and are very helpful when a pt is sick and has multiple drips infusing. Hope this helps:)

[geekgolightly, BSN, RN]

At our hospital we give PICC's if we think the patient might be in hospital for a week or more. It's wonderful for the patient (less times getting stuck, easier on the veins and psyche) and wonderful for the nurses (less time spent putting in a million IVs and easier to get blood). I adore PICCs.

Thanks for the info about who likes which kinds of central lines. I prefer SC lines as well for the reason mentioned: it's more secure.