Accessing Central Venous Catheters

[nsmedic393]

Do your protocols allow allow you to access CVCs, PICCS and indwelling catheters?

What specific criteria if any do you need to access these devices? Does anybody carry Huber needles and what techniques to use to access the devices?

[TechMedic05]

Up here in New Hampshire, that's a rather gray area [heh, it's EMS, what isn't?]. Typically, we do not use them for access unless it's an inter-facility transfer and the access whether it be PICC, CVC, etc., in which we can continue it. NH's protocols allow for -any- facility initiated treatment to be continues, except for blood products...but that may soon be changing. I have not heard of anyone carrying non-coring needles for indwelling central lines. Our medical control has mentioned if encountered with someone with already in place access, and peripheral access isn't obtainable, or difficult, and you kinda need access,to contact them for options.

The adult IO access is becoming much more popular up here, however.

[Ridryder 911]

Ironically, I just finished the protocol to access "ports" for my service. PICC line are really not considered a "central line" since they are really placed peripheral and inserted with a long catheter. I am PICC certified, to place them in ER, and access them all the time in the field... it is just an I.V.

Central lines should be easily accessible as well, many patients are sent home now these days. It is asinine to try to establish a peripheral line... (there is a reason they have central line). Use aseptic procedures, and follow local protocols. Don't have any, I highly suggest getting some.

More and more patients will be sent home with ports, central line devices, PICC lines. So many now receive in-home chemo, antibiotics therapy, etc.. EMS needs to step up and become familiar with these devices.

Be safe,

R/R 911

[TechMedic05]

Rid-

I agree with you completely. Doc's and nurses still come up with silly reasons to not use a PICC line, like, "How can you know if it's correctly placed?" - Aside from being D/C'd from the hospital/ nsg home with it?

As far as local option/ protocols, NH's trying to eliminate all local options, and sticking with a statewide protocol. Although generally aggressive and progressive, [except for removing RSI for all but maybe 3-4 services...and high does Solu-medrol for SCI's] they haven't addressed usage of central access. They try to base protocols off of emergent work, and neglect the rapidly growing 'interface' of still-sick patients going home or to rehab/ nursing facilities.

And- If it's a PICC line, isn't that a Peripherally Inserted Central Catheter? NH consideres it Central, so generally hands-off for me.

[heavydutyfd]

Maryland Region 3....

Only after all other means of I.V. access* have been exhausted, with patient meeting priority 1 standards, and after medical consultation**.

*peripheral (arms then legs), external jugular, adult I.O.

** you better present one hell of a presentation, I in 12 yrs have NEVER heard of a doctor giving the "OK".

[nsmedic393]

We have protocols for accessing the sites. For the indwelling caths we are supposed to use a 23g needle attached to a 10set. Night before last I had a patient with mild CHF. She was responding well to NTG but I would have liked to get IV access to give MS and Lasix. I couldn't get a peripheral IV and our protocols state we can only access the catheters for 1.shock 2.Cardiac Arrest and 3.Status epilepticus

[tinman694]

Down here in the south dem things is dangerous! You can't touch'em.

(Thought the Colloquialism might be cute)

We have a perception problem down here that you cannot do aseptic technique in an ambulance (go figure)

Think it would be much easier for many of the regulars we have (many who have ports) to get access quickly and with less pain/problems--but then again, who thinks about these things?

[buckeyedoc]

Our 2006 protocols have allowed us to access PICC, central lines and Dialysis Fistulas in codes.

[Dustdevil]

Our 2006 protocols have allowed us to access PICC, central lines and Dialysis Fistulas in codes.

I'd like to know if dialysis fistulas are being covered in paramedic schools these days. I am sure they are not being covered universally, but I'm interested in knowing how many medics were told about them in school. I know it was never mentioned in the Cracker Jack box I got my diploma from. And the first time I saw one I thought, "Wow! What luck! Look at this vein!" The ER was obviously none too pleased about that. :oops:

[Just Plain Ruff]

we were taught about it and it was drilled into our heads DO NOT ACCESS THAT SHUNT DO NOT ACCESS THAT SHUNT DO NOT ACCESS THAT SHUNT

But in the end and the patient is coding and the only access you have is the shunt and you are 30 minutes out from the nearest hospital - you can bet your rear end that I'm gonna get orders and instructions to access that shunt. Let the patient crash and code while they had a good shunt - not on my watch.