jacquie9

The central line that is placed directly into the subclavian vein has direct, close access to the heart. A central line that is peripherally placed is just that.....peripheral, inserted into a vein in the arm that travels up into the subclavian, then into the heart.....a much longer path to travel, and a much smaller vein until it terminates into the SVC/Atrium. An analogy made could be comparing a directly placed central line into the subclavian exiting through the subclavian, and a central line placed into the subclavian, but exiting through a tunnel under the skin, with a dacron cuff about 1" from the exit site. You are correct in that an impregnated antimicrobial patch decreases the incidence of infection, but does not eliminate it. The area that I am presently employed is on the IV Team at a University hospital that encompasses three hospitals connected through tunnels. The largest majority of our patients are transplant patients receiving livers, kidneys, hearts, lungs, and small bowels. A very high population of immune depressed patients, as well as major traumas, neuros and cardiac. We place on an average of 25 to 30 PICCs per day. Our centrally placed catheters (directly into the subclavian or IJs) are usually replaced after a few days by PICC lines (Peripherally Inserted Central Catheters) Hope I have addressed your questions...

Not to insult your intelligence but a PICC IS a central line, but inserted peripherally (Peripherally Inserted Central Catheter) The advantage of a PICC is that it can be left in from months to a year or more. A non peripherally inserted central line is inserted directly into the central vein, therefore there is a much higher incidence of infection, and they should not be left in any longer than a week.

You cannot simply insert a 45cm PICC in any patient to the hub. At the facility in which I am employed, we have been using Ultra Sound for venous identification, and since our insertions are now much higher above the antecubital, (Brachial/Cephalic/High Medial) the 45cm catheter is most desirable. You still must measure the patient from the insertion site to the SVC. The closer the hub is to the insertion site, the less chance there is to the catheter being tugged upon. When Radiology inserts PICCS, they are always to the hub. It also depends upon the type of PICC you are using. If you use an open ended PICC, they can be trimmed to the "ideal" length, but if you are using a double lumen Groshong, they cannot be trimmed and measurement must be more accurate if you wish it to be inserted up to the hub. With a single lumen Groshong, it can be trimmed to the desired length. We also now use stat-locks to secure our catheters, and change them once a week along with our dressing changes. If the catheter is not inserted to the hub, we place a flexible wing adapter to the insertion site, then attach it to the stat-lock. The new Groshongs (which we use) now have much more durable extension lumens and since these have been released from the company (Bard), I cannot remember the last time I have repaired one. Who are the new certifieds? They are "wrong" if they are telling you that a PICC is a PICC if it is in the subclavian. It is only considered a PICC if it is in the SVC/Cavio Atrial Junction, or the Right Atrium. If a PICC is in the sub-clavian, it is considered to be "Mid-clavicular". If it is anywhere from 6 ins to axilary, it is then considered to be a mid-line. FYI, it is also recommended that TPN, and Vancomycin only be infused through a "true PICC", SVC or R. Atrium, because of the nature of sub-clavian stenosis. The pH of Vancomycin is so caustic that it causes severe irritation of the peripheral, and subclavian vessel and should only be infused in a true PICC placed catheter, and we all know the rules of TPN. I hope this information has helped.