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
- Midline PICC -- since these do not end in a central vein, AND they have a much lower infection rate (ref: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)
- any intravascular device that does not have a lumen (e.g. pacemaker wires)
TISS Special Cases
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.
Legacy
We also used to code QA Infection CLI.