Chart — Critical Care · IV Therapy
Central Line Types Comparison Chart
PICC vs non-tunneled CVC vs tunneled catheter vs implanted port vs hemodialysis catheter — site, lumens, dwell time, CLABSI risk, dressing schedule, flush protocol, Huber needle requirement, blood draw, indications, advantages, and disadvantages.
Educational use only. Central line selection requires provider decision-making based on patient clinical context. Follow your institution's central line policies. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
Central Venous Access Type Comparison
| Attribute | PICC | Non-Tunneled CVC | Tunneled Catheter (Hickman / Groshong) | Implanted Port | Hemodialysis Catheter |
|---|---|---|---|---|---|
| Access site | Basilic, brachial, or cephalic vein (antecubital or upper arm) — advanced to SVC | Internal jugular (IJ), subclavian, or femoral vein | IJ or subclavian vein; catheter tunneled subcutaneously to exit site on chest | Subcutaneous reservoir placed on chest wall; catheter to SVC | IJ (preferred) or femoral; or tunneled HD catheter (Mahurkar) to IJ |
| Lumens | 1–3 lumens (single, double, or triple-lumen PICC) | 1–3 lumens (single, double, or triple-lumen) — most common: triple-lumen | 1–3 lumens; open-ended (Hickman) or valved (Groshong) | 1 lumen (single) or 2 lumens (double port); accessed via Huber needle | 2 lumens (arterial/venous) for HD flow; some have 3rd CVC lumen |
| Dwell time | Weeks to months (intermediate-term: 4–13 weeks typical; can last longer) | Days to weeks (short-term acute care only) | Months to years (long-term: Dacron cuff creates infection barrier) | Years (most durable; fully implanted when not accessed) | Non-tunneled: days to weeks. Tunneled HD catheter: weeks to years. |
| CLABSI risk | LOW–MODERATE (upper arm insertion reduces risk vs femoral CVC; PICC DVT risk notable) | HIGH — especially femoral. Site risk: femoral > IJ > subclavian | LOW — Dacron cuff creates subcutaneous tissue barrier against microbial migration | LOWEST — completely subcutaneous when not accessed; minimal infection risk between uses | Variable: non-tunneled femoral = high; tunneled HD catheter = lower |
| Dressing change | Transparent dressing every 7 days (or sooner if soiled/loose). Arm circumference check q visit. | Transparent dressing every 7 days. Gauze 48h if diaphoresis/bleeding. Chlorhexidine disk (Biopatch) at site. | Transparent dressing every 7 days. Do NOT disturb Dacron cuff — it anchors the catheter in tissue. | Only when accessed: transparent dressing over Huber needle, change every 7 days. | Same as CVC or tunneled protocol depending on catheter type. |
| Flush protocol | 10 mL NS before/after each use (pulsed flush). Heparin lock per protocol if specified. | Open-ended: 10 mL NS + heparin lock (unused lumens). Valved (Groshong): NS only. | Hickman (open): 10 mL NS + heparin lock. Groshong (valved): NS only — no heparin. | When accessed: 10 mL NS after each use. Monthly heparin flush when not in use (per protocol). | Heparin 1,000–5,000 units lock each lumen after HD session (per protocol). |
| Huber needle required? | No | No | No | YES — non-coring Huber needle REQUIRED. Regular needles damage septum (core the septum → port failure). | No |
| Blood draw | Yes — discard 3–5 mL first. Withdraw slowly. | Yes — discard 3–5 mL first. Never draw from TPN/heparin/vasoactive lumen. | Yes — discard 5–10 mL per lumen (larger dead space). Draw slowly. | Yes — access with Huber needle first. Discard 5 mL. Flush 20 mL NS after. | Dedicated HD lumens only. Not for routine blood draws. |
| Indications | Long-term antibiotics (> 5–7 days), TPN, chemotherapy, frequent labs, poor peripheral access, home IV therapy | Vasopressors (must have central access), TPN (short-term), CVP monitoring, large-volume resuscitation, emergency access, hemodynamic monitoring | Long-term TPN, prolonged IV antibiotics, chemotherapy, home IV therapy, bone marrow transplant | Intermittent chemotherapy, periodic IV medications, home infusion patients with long intervals between use | Hemodialysis access when fistula/graft unavailable; CRRT in ICU |
| Advantages | Easier insertion than CVC (no subclavian/IJ risks). Peripheral insertion. Lower CLABSI than non-tunneled CVC. Good for outpatient/home therapy. | Rapid access. Large-bore lumens. Multiple lumens for simultaneous incompatible drugs. CVP measurement. Immediate use. | Long dwell time. Lower infection rate. Dacron cuff prevents migration. Suitable for home use. | Lowest infection risk. Completely subcutaneous between uses. High patient quality of life. Years of durability. | High flow rates (300–400 mL/min) required for HD. Immediate access when fistula unavailable. |
| Disadvantages | PICC-associated DVT (arm). Must verify tip by CXR before first use. No BP cuff/venipuncture on PICC arm. Dislodgment risk with arm movement. | Pneumothorax (IJ, subclavian). Air embolism risk. Highest CLABSI risk overall. Short-term only. Requires CXR post-insertion. | Surgical procedure for insertion. Complex removal. Dacron cuff complicates removal once embedded. | Requires Huber needle access (procedural skill). Cannot be used emergently without proper access equipment. Surgical placement. | Cannot be used for standard IV medications (dedicated HD use). Increased thrombosis risk. Infection risk. |
| Insertion responsibility | PICC-certified RN (many institutions) or IR/vascular surgery | MD/PA/NP (intensivist, anesthesia, hospitalist) | IR or surgery (tunneling requires procedure) | IR or surgery (subcutaneous implantation) | MD/PA/NP; tunneled HD catheter may be placed by IR |
CLABSI Risk Summary
| Risk Level | Catheter / Site | Why |
|---|---|---|
| Highest | Femoral non-tunneled CVC | Proximity to perineal flora, difficult dressing maintenance, patient mobility limits asepsis, high skin flora burden |
| High | IJ non-tunneled CVC | Near mouth/tracheal secretions; dressing loosening with neck movement; higher flora burden than subclavian |
| Moderate | Subclavian non-tunneled CVC | Lower infection rate vs IJ/femoral — but highest pneumothorax and subclavian thrombosis risk at insertion |
| Low | PICC (upper arm) | Peripheral insertion, away from central flora. However: PICC-associated upper extremity DVT is a notable risk. |
| Lower | Tunneled catheter (Hickman) | Dacron cuff creates tissue barrier against microbial migration from exit site to bloodstream |
| Lowest | Implanted port | Fully subcutaneous when not accessed — no external catheter to contaminate between uses |
NCLEX Pearls
Implanted port REQUIRES non-coring Huber needle — regular needles core the septum and destroy the port permanently.
PICC: no BP cuff, no venipuncture, no heavy lifting on arm — risk of catheter dislodgment, PICC thrombosis, and compression damage.
Femoral CVC = highest CLABSI risk (groin flora, difficult dressing maintenance). Advocate to avoid when alternatives exist.
Post-CVC insertion CXR mandatory before first use — confirms SVC tip position AND rules out pneumothorax. Never use before CXR is read.
Groshong (valved) catheter: flush with NS only — no heparin needed. Hickman (open-ended): needs heparin lock.
Air embolism prevention: Valsalva or held expiration when CVC hub is open to air. Left lateral decubitus + Trendelenburg if air embolism suspected.
Vasopressors require central line — peripherally administered vasopressors cause severe tissue necrosis with extravasation.
Related Resources
Standards & sources
Fact-checked Jun 20, 2026This page is written to align with Society of Critical Care Medicine (SCCM) · Surviving Sepsis Campaign · American Association of Critical-Care Nurses (AACN). It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →