Central Line

This article defines Central Lines to make sure we use the same definition in

• Iatrogenic, infection, central venous catheter-related bloodstream infection (CVC-BSI, CLI)
• Central Venous Catheter at 2300 (TISS Item)
• Central venous catheter (TISS Item)
• CVC placement, any location

CL means Central Line

• A CL is a #vascular access catheter that passes through or has a tip ending in one of the #great vessels.
• It may be used for infusion, blood sampling, or hemodynamic monitoring.
• It can be temporary, or long-term/permanent.

great vessel

• aorta
• pulmonary artery
• superior vena cava
• inferior vena cava
• brachiocephalic veins
• internal jugular veins
• subclavian veins
• external iliac veins
• common iliac veins
• femoral veins

vascular access catheter

• subclavian vein catheter
• internal jugular vein catheter
• PICC (Peripherally Inserted Central Catheter)
• Swan-Ganz (pulmonary artery) catheter -- note placement of this has its own code Swan-Ganz (Pulmonary Artery Flotation) Catheter placement
• Broviac
• Groshong
• Quinton
• Hickman
• ASHE catheter
• hemodialysis catheter (e.g. Vascath)
• implanted ports (e.g. Port-a-cath)
• central line introducer -- i.e. even if it does not have a central line in it
• introducer for a temporary pacing wire

Not counted as Central Lines:

• arterial catheters inserted into an artery
• ECMO - (ECMO, VV, ECMO, VA)
• IABP
• VAD; IMPELLA
• A-V fistula
• regular peripheral IVs
• any intravascular device that does not have a lumen (e.g. pacemaker wires)

TISS Special Cases

Are the following special cases really only for TISS or should they apply for the other purposes above? Specifically, the original content in CVC placement, any location (now removed) said "***thus, a so-called midline PICC, that goes in the brachial vein and ends in the brachial vein is NOT a CVC". Ttenbergen 12:35, 2019 January 21 (CST)

• SMW

• Cargo

• Categories

Special Case - Code peripheral/midline PICC lines

• We will not consider a so-called midline PICC (which is not technically a Peripherally Inserted Central Catheter at all, because it doesn't end in a central vein) as a CVC for any purpose as of January 2019. The reasons are: (a) as above it's not a central catheter, and (b) it does not have the same infection risk as a central catheter (ref is: DG Maki, DM Kluger and CJ Crnich. The risk of bloodstream infection in adults with different intravascular devices: a systematic review of 200 published prospective studies. Mayo Clinic Proceedings 81(9):1159-1171, 2006).
  • While it does have similar nursing workload as a PICC or an untunelled CVC, the fact is that the use of our TISS scoring to measure nursing workload is a relatively rare/minor use.

Special Case - unused, fully buried (entirely internal) vascular access devices (such as Port-a-Cath)

• We previously said NOT to count these in TISS if they've not been accessed at all during the admission. However, this ignores the situation when it might well have been accessed at a time prior to but close to admission (e.g. got chemotherapy through it in the Onc Clinic as an outpatient a few days prior to admission). Because the possibilities here are so numerous, for simplicity, we WILL count these on TISS even if not being used (per Allan, Dec 28, 2018).

Legacy

We also used to code QA Infection CLI.