Veins, Drains, and Brains (nothing rhymes with automobiles except glockenspiels)
We’re familiar with IVs and ETs but there are a variety of tubes going into or out of patients.
Veins
A central venous catheter, (Braner, Lai, Eman, & Tegtmeyer, 2007)is usually placed via the right subclavian vein by a physician is advanced into the superior vena cava (Braner, Lai, Eman, & Tegtmeyer, 2007).
A PICC (peripherally inserted central catheter) is usually placed by a nurse via the right antecubital vein and advanced into the superior vena cava (Davis & Kokotis, 2004)
Central lines are used to give intravenous fluids, blood transfusions, chemotherapy, and other drugs. The catheter is also used for taking blood samples. It may stay in place for weeks or months and helps avoid the need for repeated needle sticks. The patient may be home and receive antibiotics, chemotherapy or dopamine infusions by a visiting nurse or community paramedic. The advantage is rather than 10 mg of a drug in a liter of fluid administered over a few hours, it can be slowly injected into the central line and the blood flow through the superior vena cave will dilute the medication as it is administered over a shorted time frame.
Drains
Nephrostomy-A catheter by percutaneous insertion may be draining an obstructed kidney. A needle is advanced under fluoroscopy or ultrasound into the renal calix from the back and attached to a leg bag or urine collection bag (Dagli & Ramchandani, 2011).
Biliary drainage-Likewise a catheter may be draining an obstructed bile duct due to cancer or a stone. (Funaki, 2007)
Abscess Drainage-Percutaneous drainage of abdominal or pelvic abscess (Gervais, et al., 2004)
Brains-While an intraoperative procedure for hydrocephalus, an internal shunt may be placed from the cerebral ventricle to either the right atrium of the heart or peritoneal cavity. (Yavuz, et al., 2013).
Once again the question “have you ever had any surgery” might better be phrased as “have you ever had any tests or procedures?”
Bibliography
Braner, D., Lai, S., Eman, S., & Tegtmeyer, K. (2007). Central Venous Catheterization — Subclavian Vein. The New England Journal of Medicine, 357(24), 26-26. Retrieved 5 29, 2023, from https://nejm.org/doi/full/10.1056/nejmvcm074357
Dagli, M., & Ramchandani, P. (2011). Percutaneous Nephrostomy: Technical Aspects and Indications. Seminars in Interventional Radiology, 28(4), 424-437. Retrieved 5 29, 2023, from https://ncbi.nlm.nih.gov/pmc/articles/pmc3312169
Davis, J., & Kokotis, K. (2004). A New Perspective for PICC Line Insertions: Cost Effectiveness and Outcomes Associated with an Independent PlCC Service. The Journal of the Association for Vascular Access, 9(2), 93-98. Retrieved 5 29, 2023, from https://sciencedirect.com/science/article/abs/pii/s1552885504703906
Funaki, B. (2007). Percutaneous biliary drainage. Seminars in Interventional Radiology, 24(2), 268-271. Retrieved 5 29, 2023, from https://ncbi.nlm.nih.gov/pmc/articles/pmc3036415
Gervais, D. A., Brown, S. D., Connolly, S. A., Brec, S. L., Harisinghani, M. G., & Mueller, P. R. (2004). Percutaneous Imaging-guided Abdominal and Pelvic Abscess Drainage in Children. Radiographics, 24(3), 737-754. Retrieved 5 29, 2023, from https://pubs.rsna.org/doi/full/10.1148/rg.243035107
Yavuz, C., Demirtas, S., Caliskan, A., Kamasak, K., Karahan, O., Guclu, O., . . . Mavitas, B. (2013). Reasons, procedures, and outcomes in ventriculoatrial shunts: A single-center experience. Surgical Neurology International, 4(1), 10-10. Retrieved 5 29, 2023, from https://ncbi.nlm.nih.gov/pmc/articles/pmc3589837
