Central lines, arterial lines, PICC lines…and more!

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When I was a med student, I was SO CONFUSED by all the types of IV lines out there. I want to outline a few useful ones, along with some reasons you might see them being used (links to videos on how to place these lines):

  • A-line This stands for “arterial line.” Inserted like “an ABG on steroids”
    • Often used during surgery so the anesthesiologist can administer meds like fentanyl, propofol, and vercuronium.
    • Used in ICU settings for patients who require frequent blood gases (patients on ventilators, bad asthmatics, etc) or continuous blood pressure monitoring when the cuff is unreliable so that pressors can be administered
  • Central line
    • Can be put in the neck (internal jugular, subclavian, axillary) or groin (femoral vein). All roads lead to the vena cava.
    • Put in for access: running multiple pressors at the same time, fluids, and medications that might not be compatible with each other in a peripheral IV, or emergent dialysis (although this is considered pretty dirty)
    • Sometimes put in for a PA catheter (Swan) which would be used to monitor pulmonary artery pressure, which is useful for evaluation of pulmonary artery hypertension or during cardiac surgery
  • HD line also called the Hickman or “permacath”
    • As the name implies, this is a tunneled catheter that is put in for hemodialysis. It’s put in the same way as a regular central line…it’s just bigger and goes under the skin to a more discreet exit site.
  • Port short for “Port-A-Cath”
    • The port is a type of central line that is used when a patient gets intermittent infusions over a long period of time, such as chemo or TPN.
  • PICC line 
    • Smaller than a central line but bigger than a midline or peripheral
    • Inserted often in the upper arm and should end up
    • Used for obtaining more access and for long-term use of IV medications (for example, sending patients home on IV antibiotics for more than a week).
  • Midline
    • Smaller than a PICC line but bigger than a peripheral
    • Used for the same reasons as a PICC (long-term use of IV medications) although it cannot take TPN or some kinds of vesicant medications
  • Peripheral line 
    • Sizes range from 14 to 24 gauge. A handy mnemonic using the colors of the IV hubs: orange=oh baby (14=large bore, trauma), grey=great (16), green=good (18), pink=poor (20), blue=bad (22), yellow=useless (24, ok for babies, bad for adults)
    • Only 18 gauge and larger can be used for blood transfusions due to risk of hemolysis
    • External jugular line or “EJ” is a kind of peripheral IV, and is usually a last resort in a patient with difficult IV access
    • If IV therapy is going to needed for more than 6 days, you need to think about putting in a midline or a PICC