Central Lines & Arterial Lines

Question 1

What is the most commonly used vein for a central line?

Answer 1

Internal jugular vein

Question 2

What are the 4 most commonly used veins for a central line?

Answer 2

1) Internal jugular vein

2) Subclavian vein

3) Femoral vein

4) Axillary vein

Question 3

Give some reasons for a central line

Answer 3

1) TPN

2) Resus with fluid or blood

3) Irritant drugs - vasopressors, amiodarone

4) Monitoring of central venous pressure

Question 4

Give some complications of CVC insertion

Answer 4

1) Failure

2) Arterial injury - puncture or accidental cannulation

3) Arrhythmia - guidewire irritates the myocardium

4) Pneumothorax (due to close proximity to apex)

5) Air embolism/entrainment

Question 5

Give some reasons for inserting an arterial line

Answer 5

1) Beat to beat BP measurement: if need careful control of BP or rapid changes are possible

2) BP cuff causes injury e.g. long surgeries

3) Regular blood gas sampling

4) Accuracy of normal BP cuff may be impaired e.g. severe hypotension

Question 6

What test should be performed prior to insertion of an arterial line?

Answer 6

Allen’s test

Question 7

Briefly describe interpretation of an arterial line waveform

Answer 7

Max height of wave = systolic BP

Lowest point of wave = diastolic BP

Dichrotic notch marks the end of systole and beginning of diastole.

Question 8

Give some complications of an arterial line

Answer 8

• Arterial thrombus
• Distal ischaemia
• Infection
• Bleeding - direct injury to vessel, disconnection
• Accidental drug injection