PICC lines can remain inserted for weeks to months (Figure (Figure2) 2). For emergent situations, the central line catheters may be non-tunneled for the purpose of easy insertion.Ī peripherally inserted central catheter or a PICC line is a thin, flexible tube that is inserted into an upper arm vein and then guided into the superior vena cava on the right side of the heart. The central lines for hemodialysis have large bores that require heparin to prevent clotting and may be tunneled for long-term use. The difference between hemodialysis and CRRT is that CRRT will provide a slower fluid removal as compared to intermittent hemodialysis which will lead to better hemodynamic stability in fluid overload patients. The other indications for dialysis include metabolic acidosis, hyperkalemia, the ingestion of certain drugs (salicylates, lithium, isopropanol, methanol, and ethylene glycol), fluid overload, uremia, and when the serum creatinine is greater than 10 mg/dL. Both are used for filtration of the blood, usually in medical emergencies like acute kidney injury, severe sepsis, fluid overload, or septic shock. ĭialysis catheters are utilized for hemodialysis and continuous renal replacement techniques (CRRT). The concern with implanted ports is that they require surgical implantation that takes more time and skill to implant than the other catheter types. įor long-term use, implanted ports are preferred as they have better cosmetic results and less infection as compared to non-tunneled catheters and tunneled catheters. They have a lower infection rate as compared to non-tunneled catheters. Tunneled catheters are preferred when intravenous access is needed for multiple times during a time period longer than one month. Because of this, they should be removed as soon as possible in order to prevent complications like infections or thrombosis. The concern that physicians have with non-tunneled catheters is that they have a short duration of use. This is because of their simplicity and easy insertion. The choice and selection of the catheter among the available options depend largely on the nature and duration of intended treatment.Ĭatheters that are non-tunneled are seen and used most frequently in emergency and acute situations. This is a review article that describes central lines, their different types, the sites of insertion, and the complications seen in association with them. The subclavian vein tends to have a lower infection rate as compared to other central line sites. Because of this, the femoral vein is avoided because of a higher rate of infection and thrombosis as compared to the subclavian vein. The ideal catheterization site would be one that has less thrombosis, lower infection rates, and fewer mechanical complications. Due to this, it would be safer to deliver the vesicant drugs through a central line rather than through a peripheral line where there is a higher chance of drug leakage. The three common sites are the subclavian vein, the internal jugular vein, and the femoral vein. Vesicant drugs are medications that can cause serious damage to the skin and muscle tissue if the drug comes into contact with them. The reasons a physician might decide that a patient needs a central line would be to deliver multiple medications, for continuous infusion chemotherapy, for parenteral nutrition, and to deliver vesicant drugs (Figure (Figure1) 1). The use of a central line is often crucial to the improvement of critically ill patients.
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