Cental iv

My wife had a hysterectomy last month. When we were in the pre op area they put an iv in her hand. When she came out of the recovery room they had put I.v.s in her other arm and her neck why would they do this?

Without seeing her chart or knowing her medical history, there could be a lot of reasons for this. They could range from anything as simple as the IV in here hand was being touchy and they were not sure it would remain patent, to maybe she had an infection and the ATB they wanted to administer was too strong for a small hand vein, and anything in between.

Ok, I thougt you got one in the neck during heart surgery. Why would they pu an iv in both hands also?

A peripheral IV (in the hand) would be used to give fluids or meds. A central line in the chest, neck or in the groin (femoral vein) is used to measure central venous pressure for fluid or blood pressure measurement. A central line can also be used to introduce pacemaker wires or pulmonary artery lines or when a large catheter is needed to give lots or fluids or to transfuse blood.

Some people's veins cannot handle peripheral IV ports for very long and it becomes infiltrated. Often the anesthesiologist will start two peripheral lines hoping to to ensure that one is always open, or because there are drugs being administered through the IV lines that are not compatible with one another.

About 20 years ago, when my then wife had her hysterectomy, all of her peripheral lines became infiltrated. For the next two days, all her meds had to be adminstered IM. When she had to go back in two years later for a repair procedure, the nurse started a peripheral line in the pre-op area and a central line was started in the Operating Room, leading to a three brached chest port. All of her meds (other than heparin) went in through that line.

Peripheral lines are commonly placed to provide IV access and to provide a route for IV medication or fluids. However they have a very limited time span before they must be changed due the risk of infection its normally every 72 hrs but can be left in place for a maximum of 120 hrs ( 5 days) providing the site is clean, not red, or feels warm/ hot to touch or painful, after this period the risk of Phlebitis (inflammation of the vein)and infection increases dramatically.

Hoverer with most peripheral lines depending on the drug ( usually antibiotics) or the rate of flow of the fluids they would require changing before that. In addition they may require replacing due to accidental dislodgement and occlusion before the 72hr or 120 hr timescale. Its very important with any peripheral lines to stop any infusion or drug administration if you notice any redness or swelling or if the patient complains of pain. As extravasation ( commonly called tissuing) can be a nasty complication and result in skin sloughing, tissue necrosis, thrombophlebitis, venous thrombosis, or severe consequences including functional impairment, residual scarring and disability.

With regards to Central lines ( which comes in single lumen and multi-lumen) which are commonly place in the neck ( internal or external jugular vein), in the Chest ( either Rt or Lt Subclavian vein) or the groin ( Rt or Lt Femoral vein) or it can be done peripherally in in case of a peripherally inserted central catheter (PICC or PIC line) usually in the ( cephalic vein, basilic vein or brachial vein).

These lines can be left in almost indefinitely. Central lines are need for the administration of certain drugs like inotropes ( adrenaline, noradrenaline, dopamine etc), chemotherapy and TPN but are used for access in difficult to cannulate patients. In addition all fluids, blood and blood products as well as all medication can be administered centrally via the central line. However a chest xray is required to confirm the position of a central line if inserted in the neck or chest.

As liquidsky mentioned a bonus of having a central line in is the ability to monitor the Central Venous Pressure (CVP) normally 2-6 mm Hg, however in my clinical environment we like it to be around 8-12 mm Hg. It is an important tool when assessing right ventricular function and systemic fluid status.

I know that the topic is a very serious one, but it's so interesting to sit and listen to all the medical talk...even though I don't understand any of it. Im literary fascinated by your real life medical knowledge. It's sexy! But I understand the seriousness of the topic. Thank you for being amazing for openly sharing your knowledge with us lay people.

I don't have a Central IV line, but did have a Power Port installed over my breast bone in October of 2013 to be used at the Cancer Center when instilling drugs and getting blood for Lab tests. The first few weeks were hectic as the tissue around the port was badly swelled which made access to the port kind of rough. But opnce the swelling subsided, it has been easy sailing in accessing the port for whatever reason.

I have a port because peripheral access is nearly impossible on me. My veins are tiny, and roll. Once accessed, they always blow. I need labs done every couple of months that require a venous draw.

Question. We only did piccs as o/p or just before d/c. If you need a central line there something big going on b/c it was one of the things you did in a trauma, ABC central line and large bore IV both sides. Is it done different in the US?