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9676_2	Broadcast history In the United States—from 1994 until 1997—The Magic School Bus originally aired on PBS (being the first television airing). It aired on PBS as part of its children's block. On PBS through South Carolina's SCETV network, it was the first fully animated series to be aired on PBS. The last episode aired (on PBS) on December 6, 1997. By the series' end, it was among the highest-rated PBS shows for school-age children. After the final episode, the show on the PBS lineup was subsequently rerun intermittently until September 25, 1998. On September 26, 1998, PBS dropped the show from its lineup in order to make room for more programs aimed at preschoolers. On that same year, Fox network (in the United States) acquired the original TV series. After Fox network acquired the TV series, it was moved to the Fox Kids block and it ran there until 2002.
9676_3	Fox Kids (on the US television) used the series as a weekday offering to fill educational television mandates for its affiliates. It aired repeats from 1998 to 2002. On September 27, 2010, The Magic School Bus was broadcast through a daily run in Qubo on US television. Then it aired on NBC (on Saturday mornings). Both the Fox Kids and Qubo airings used a shortened version of the opening. Also the PBS, TLC, and Discovery Kids airings (on US television), CBC Kids (on Canada television), and the VHS and DVD versions used the original version of the opening.
9676_4	On US television, after its permanent disappearance from PBS in 1998 --in order for PBS to make room for other new programs aimed at preschoolers on its lineup-- and Fox Kids in 2002, TLC and Discovery Kids (on US television) chose to air it. On US television, TLC aired it from February 24, 2003 until 2008 while Discovery Kids aired it from 2004 until 2009 (as part of the Ready Set Learn block). In Canada, it aired on CBC Kids (from 2000 until 2003), Teletoon, and Knowledge Network. In the United Kingdom, it aired on Channel 4, Nickelodeon, and Pop. Since 2005, Canada-based studio Nelvana acquired the original TV series and sold it to the Latin American versions of Cartoon Network and Nickelodeon. As of 2021, the show is currently distributed by 9 Story Media Group. Home media
9676_5	The series (through home media) was released on VHS from 1995 to 2003, DVD from 2002 to 2013, DVD (by New Video Group) in Region 1 (which are the rereleases of the Warner Home Video DVDs) on July, 31, 2012, and Netflix on August 15, 2013. The series was originally released on VHS. The series on VHS was distributed by KidVision (a division of WarnerVision Entertainment) between 1995 and 2003. On DVD, it was distributed by Warner Home Video (through Warner Bros. Family Entertainment and WarnerVision Entertainment) between 2002 and 2013. On July 31, 2012, New Video Group released the complete series on DVD in Region 1, as well as rereleases of the Warner Home Video DVDs. On August 15, 2013, Scholastic announced the series' availability on Netflix. .
9676_6	Reception In a 2007 column for the online edition of The Wall Street Journal, Jason Fry expressed an overall appreciation for the series, but wrote that the episode "The Magic School Bus Gets Programmed" illustrated the rapid pace of technological change over the ten years since it first aired. He explained the episode presented an old-fashioned "technology-gone-amok" story about the respective roles of programmer and machine that was no longer relevant to children growing up in 2007. He suggested that an updated version of the episode would have focused instead on the perils of Internet searches and on network concepts surfacing at the time. Awards and nominations Games Numerous computer and video games associated with the series were released from 1994 to 2000, and were typically amalgamations of storylines from both the original book series and the television show. The games were published by Microsoft Home.
9676_7	A video game titled The Magic School Bus: Oceans was released for Nintendo DS on October 25, 2011, ten years after the release of the last game. This is the only game to be released on a Nintendo platform. Revival series On June 10, 2014, a new series was announced by Netflix and Scholastic Media titled The Magic School Bus 360°. The new iteration of the franchise features a modernized Ms. Frizzle and high-tech bus that stresses modern inventions such as robotics, wearables and camera technology. The producers hoped to captivate children's imaginations and motivate their interest in the sciences. 9 Story Media Group would produce the series. Producer Stuart Stone, who voiced Ralphie in the original series, explained that The Magic School Bus 360° will feature some of the original voice actors in different roles. The series' voice cast is based in Los Angeles and Toronto with Susan Blu as the Los Angeles voice director and Alyson Court as the Toronto voice director.
9676_8	In February 2017, Netflix announced that Saturday Night Live cast member Kate McKinnon was cast in the role of Fiona Felicity Frizzle, the younger sister of Ms. Frizzle, now Professor Frizzle, again voiced by Lily Tomlin. By this point the title of the series had been changed to The Magic School Bus Rides Again. Lin-Manuel Miranda performed the theme song. On September 29, 2017 the series premiered on Netflix. Film On June 25, 2020, a film adaptation was announced and Elizabeth Banks is cast to play Ms. Frizzle. References External links The Magic School Bus at Netflix
9676_9	The Magic School Bus 1990s American animated television series 1990s American comic science fiction television series 1994 American television series debuts 1997 American television series endings 1990s Canadian animated television series 1990s Canadian comic science fiction television series 1994 Canadian television series debuts 1997 Canadian television series endings American children's animated adventure television series American children's animated comic science fiction television series American children's animated education television series American children's animated science fantasy television series American television shows based on children's books American children's animated comedy television series Canadian children's animated adventure television series Canadian children's animated comic science fiction television series Canadian children's animated education television series Canadian children's animated science fantasy television series
9676_10	Canadian television shows based on children's books Canadian children's animated comedy television series Buses in fiction English-language television shows PBS Kids shows PBS original programming ITV children's television shows Fox Broadcasting Company original programming Fox Kids original programming South Carolina Educational Television Science education television series Television series by Nelvana Television series by 9 Story Media Group Television series about size change Television series about shapeshifting Animated television series about children Animated television series about animals Elementary school television series
9677_0	The Sunshine Building is a historic six-story building in downtown Albuquerque, New Mexico. It was built in 1924 by local theater owner Joseph Barnett and houses the Sunshine Theater as well as commercial space and offices. The Sunshine operated primarily as a movie theater until the 1980s, though it was also equipped for Vaudeville shows and other live performances. Since 1990 it has operated as a live music venue, hosting many notable acts. The building was listed on the New Mexico State Register of Cultural Properties in 1985 and is also an Albuquerque City Landmark. The building was designed by the El Paso firm of Trost & Trost and is of reinforced concrete construction with a facade of yellow brick. The architectural style is Renaissance Revival. The building was known for having what was believed to be the last manually operated elevator in New Mexico.
9677_1	One of the building's longest running commercial tenants was F. D. Fogg and Company, a local jeweler which operated there from 1948 to 1985. The company closed in 2004 after 83 years in business. The TV Show In Plain Sight filmed the exterior of this location, as the fictional office of the US Marshals' Witness Protection Service.
9677_2	History The Sunshine Building was built in 1923–24 by Joseph Barnett (1866–1954), an Italian-American businessman who arrived in Albuquerque penniless in 1896 and worked his way up through the saloon and theater business to become one of the city's largest property owners. By the 1920s, Barnett already owned two theaters in the city, the B at 200 West Central and the Lyric at 312 West Central, but planned an even larger one for his new building along with five floors of offices. The building was constructed on the former site of the White Elephant building, a two-story adobe structure dating to 1881 which once housed a popular gambling hall and saloon. The Sunshine Building was designed by the El Paso firm of Trost & Trost, which was also responsible for several other buildings in the immediate area including the Rosenwald Building, Occidental Life Building, and First National Bank Building.
9677_3	The Sunshine Theater opened on May 1, 1924, with a showing of the Ramón Novarro film Scaramouche. With a seating capacity of 1,200, central heating and cooling, and fireproof reinforced concrete construction, it was advertised as "the most modern and beautiful theater in the southwest" and was considered Albuquerque's first movie palace. The Albuquerque Journal reported that the opening was a "grand success" with the theater filled to capacity for multiple showings. The theater was equipped for both films and live performances, including the traveling Vaudeville shows that were popular in the 1920s. The building also contained 73 office rooms on the upper stories and five ground-floor commercial spaces.
9677_4	In 1935, Barnett merged his theater interests with those of the Bachechi family, including the KiMo Theater, which put most of Albuquerque's theaters under the same ownership. By 1952, the chain, Albuquerque Exhibitors, controlled 10 local theaters and had 170 employees. The company leased its theaters in 1956 to the Texas-based Frontier Theaters chain, which was taken over by Commonwealth Theaters in 1967. Commonwealth chose not to renew its lease on the Sunshine when the original lease expired in 1974, citing a lack of customers, and the theater stopped showing first-run films. Later it switched to classic 1930s and 1940s movies, then Spanish-language films.
9677_5	In 1983, the Sunshine Building was proposed for demolition in order to build a "Festival Marketplace" development. Supporters of the project believed it would revitalize the mostly vacant area around First and Central, while preservationists opposed the demolition and organized a "Save the Sunshine" committee. The debate was reported in the National Trust for Historic Preservation's national Preservation News publication in 1984. Ultimately, the project was abandoned. In 1990, the Sunshine Theater was converted into a live music venue. One of the first acts to perform there was Soundgarden (mistakenly identified as "Sound Garden" in the local press) on February 14, 1990. The theater has remained one of Albuquerque's most popular mid-size concert venues and continues to host live music as of 2019. Architecture
9677_6	The Sunshine Building is a six-story, concrete-framed structure at the southeast corner of Second Street and Central Avenue. The building is tall and has a footprint of . It is faced with marble on the ground floor and yellow brick on the upper levels. The architecture is usually identified as Renaissance Revival, with decorative brickwork and pilasters, a heavy cornice, and a balustraded parapet. The building is further decorated with swags, medallions, and other ornaments. Like the nearby First National Bank Building, the Sunshine Building was constructed with blank walls on two sides to accommodate neighboring structures. By the time of the 1980s Festival Marketplace controversy, the building was the only structure left on the block and its detractors criticized the "not so handsome" wall greeting traffic entering Downtown. In 2001, the Century Theatres Downtown building was built next to the Sunshine, obscuring the blank walls.
9677_7	The building has ground-floor commercial space and five floors of offices wrapped around the central theater space. In its original configuration, the theater had 800 orchestra seats and 400 balcony seats, though most of the seating was removed when it was converted for live music use. The proscenium arch is wide by high, and the fly gallery has a height of from the stage to the grid deck. The balcony is reached from staircases on either side of the theater, with a mezzanine containing restrooms. The office section has a separate entrance lobby opening onto Second Street. The building was notable for having what was believed to be the last manually operated elevator in New Mexico, which was staffed by elevator operators until at least 1989.
9677_8	Sunshine Theater The Sunshine Theater, which occupies a significant portion of the building, operated as a movie theater from 1924 until the 1980s and has since been remodeled into a popular live music venue. The Sunshine Theater has hosted a number of notable acts such as The Strokes, Snoop Dogg, Deltron 3030, Stone Temple Pilots, The Smashing Pumpkins, Queens of the Stone Age, The Dead Weather, Arctic Monkeys, Modest Mouse, Rancid, Coheed and Cambria, Awolnation, Cannibal Corpse, Ratatat, Social Distortion, Pennywise, Hollywood Undead, Deftones, Nightwish, Melanie Martinez, Damian Marley and Deadmau5 among others. The Sunshine Theater's set up is an open floor, a large balcony, and a bar that seats a 21 and older audience, in all they accommodate about 1,000 people. The theater is the most popular venue in the Albuquerque metro area to accommodate smaller but still notable acts, many with five or more shows in one month. References External links Sunshine Building (Emporis)
9677_9	Buildings and structures in Albuquerque, New Mexico Theatres in New Mexico Music venues in New Mexico Commercial buildings in Albuquerque, New Mexico Office buildings completed in 1924 New Mexico State Register of Cultural Properties Commercial buildings on the National Register of Historic Places in New Mexico Landmarks in Albuquerque, New Mexico Trost & Trost buildings Buildings and structures on U.S. Route 66 Albuquerque, New Mexico
9678_0	Mount Garibaldi is a potentially active stratovolcano in the Sea to Sky Country of British Columbia, north of Vancouver, British Columbia, Canada. Located in the southernmost Coast Mountains, it is one of the most recognized peaks in the South Coast region, as well as British Columbia's best known volcano. It lies within the Garibaldi Ranges of the Pacific Ranges. This heavily eroded dome complex occupies the southwest corner of Garibaldi Provincial Park overlooking the town of Squamish. It is the only major Pleistocene age volcano in North America known to have formed upon a glacier. Although part of the Garibaldi Volcanic Belt lies within the Cascade Volcanic Arc, it is not considered part of the Cascade Range. Human history
9678_1	Indigenous people
9678_2	To Squamish people, the local indigenous people of this territory, the mountain is called Nch’ḵay̓. In their language it means "Dirty Place" or "Grimy One". This name of the mountain refers to the muddy water in the Cheekye River. This mountain, like others located in the area, is considered sacred for it plays an important part in their history. In their oral history, they passed down a story of the flood covering the land. During this time, only two mountains peaked over the water, and this mountain was one of them. It was here that the remaining survivors of the flood latched their canoes to the peak and waited for the waters to subside. The mountain also serves as weather indicator to the people, as when clouds cover the face of the mountain, it signals the coming of rain or snow. Cultural ceremonial use, hunting, trapping and plant gathering occur around the Mount Garibaldi area, but the most important resource was a lithic material called obsidian. Obsidian is a black
9678_3	volcanic glass that was used to make knives, chisels, adzes, and other sharp tools in pre-contact times. This material appears in sites dated to 10,000 years ago up to protohistoric time periods. The source for this material is found in upper parts of the mountain area in higher elevations that surround the mountain range.
9678_4	Later history British Explorer Captain George Vancouver reached Howe Sound in June 1792 and became the first European to see the mountain. During this time George Vancouver met and traded with the local natives in the area. In 1860, while carrying out a survey of Howe Sound on board the Royal Navy survey ship HMS Plumper, Captain George Henry Richards was impressed by a gigantic mountain dominating the view to the northeast. Captain Richards, and his officers, renamed the mountain after the Italian military and political leader Giuseppe Garibaldi, who that year had succeeded in unifying Italy by patriating Sicily and Naples. In August 1907, the Vancouver mountaineers A. Dalton, W. Dalton, A. King, T. Pattison, J.J. Trorey, and G. Warren reached the summit of Mount Garibaldi. The views from the peak inspired the establishment of summer climbing camps at Garibaldi Lake. This early interest led to the creation in 1920 of a park reserve.
9678_5	In 1927, Garibaldi was made into a large wilderness park called Garibaldi Provincial Park. Named after Mount Garibaldi, this 1,946.5 square kilometre park was established to protect the rich geological history, diverse vegetation, iridescent waters, abundant wildlife, and rugged mountains, many of which are capped by glaciers.
9678_6	When skiing caught on in the 1940s, Vancouver skiers began to search the glaciers and rugged mountains within the park. Early skiing was limited to the more easily reached area around Garibaldi Lake. In the winter of 1944, a club group completed the first possible ski of Mount Garibaldi. The famous mountaineers Don and Phyllis Munday also completed many tracks. In the 1944–45 Canadian Alpine Journal, the Mundays reported a ski attempt on Mount Garibaldi with Phil Brook, who was a friend of the Mundays. They skied on Sphinx Glacier and scrabbled Panorama Ridge just north of Garibaldi Lake during the same trip. Most importantly, during this period a road was built on Paul Ridge near the small community of Squamish at the north end of Howe Sound, thereby affording better vehicle approach to the highlands near Mount Garibaldi. With easier access Vancouver skiers spent even more time on the glaciers of Mount Garibaldi. The result of this was the formation in the 1940s of the Garibaldi Névé
9678_7	Traverse, an overnight adventure that (weather permitting) can include a fine descent of Mount Garibaldi.
9678_8	Subsidiary peaks The broad top of Mount Garibaldi contains three named peaks. The highest peak is named as the mountain itself, reaching above sea level. The second highest peak is the sharp pyramid of Atwell Peak at the southern edge of the summit plateau, which reaches a height of and lies on the southwest end of Garibaldi Provincial Park. This peak is named after Atwell Duncan Francis Joseph King, leader of the first ascent of Mount Garibaldi in 1907. The lowest of the three is the rounded Dalton Dome, high, west of the highest summit. This peak is named after Arthur Tinniswood Dalton, one of the guides of the 1907 ascent.
9678_9	A feature on the north side of the mountain, known as The Tent, reaches and lies in Garibaldi Provincial Park. Another minor summit on the south side of the mountain, high, is known as Diamond Head (sometimes Little Diamond Head) for its resemblance to Diamond Head in Hawaii. Diamond Head was the site of a ski proposal and small lodge, now derelict. On the northwest side of Mount Garibaldi, Brohm Ridge lies outside the western boundary of Garibaldi Provincial Park. The Sharkfin sticks up out of the Warren Glacier on the northeast side of the mountain with a height of , just northeast of Squamish. Columnar Peak rises on the south side of the mountain with a height of , just southwest of Mamquam Lake at southwest end of Garibaldi Provincial Park. Two pinnacles of volcanic rock south of Mount Garibaldi's summit, which attain heights of and , have been known as The Gargoyles since 1978. Glaciers and icefields
9678_10	Two pocket glaciers lie right below the east side of Atwell Peak, the Diamond Glacier to the southeast and the upper Bishop Glacier to the northeast. Straight north of Atwell toward Mount Garibaldi lies a small, high-elevation ice cap called the Cheekye Glacier, the name of which is associated with Cheekye River. A large icefield lies on the eastern and northern flanks of Mount Garibaldi called the Garibaldi Névé. Its drainage is to the east into the Pitt River, to the southwest into Garibaldi Lake. It has an area of and is an area of substantial snowfall with more than in many winters. The Garibaldi Névé is usually accessed from the south through the Bishop Glacier or from the north through the Sentinel Glacier. Climbing and recreation
9678_11	Mountain climbing on Mount Garibaldi is fairly difficult; it is fairly steep-sided and involves climbing very loose rotten lava and volcanic ash. Fortunately, Mount Garibaldi has large areas of massive glaciation and extensive snowfields. The eastern and northern flanks of the mountain are smothered by the Garibaldi Névé where the finest climbing opportunities exist, making the easiest route a glacial travel or snow climb. Routes keep mostly to the alpine glaciers and snow slopes, which are abundant in winter and spring, but eventually melt in late spring and commonly vanish after June or July of most years. After the snow and ice melts, fissures and fractures can pose difficulty and danger, and avalanches from higher peaks of the mountain are a hazard. For this reason, early season, cold-weather ascents are recommended for most routes up Garibaldi.
9678_12	Hiking, photography, and camping are popular in the Garibaldi area. Several trailheads provide access to the backcountry. In mid to late summer, visitors pass through meadows of wildflowers along alpine trails. Garibaldi Provincial Park is also popular for winter sports, including backcountry skiing and snowshoeing. Geology Mount Garibaldi lies within the Coast Plutonic Complex, which is the single largest contiguous granite outcropping in North America. The intrusive and metamorphic rocks extend approximately along the coast of British Columbia, the Alaska Panhandle and southwestern Yukon. This is a remnant of a once vast volcanic arc called the Coast Range Arc that formed as a result of subduction of the Farallon and Kula Plates during the Jurassic-to-Eocene periods. In contrast, Garibaldi, Meager, Cayley and Silverthrone areas are of recent volcanic origin.
9678_13	Mount Garibaldi is one of the few Cascade volcanoes that is made exclusively of dacite (Glacier Peak is the other). The mountain has a unique asymmetrical shape because its main cone was constructed atop part of a large glacier system associated with the Cordilleran Ice Sheet that has since melted away. Unlike many of the other Cascade volcanoes to the south, Garibaldi does not dominate the surrounding landscape, which consists of many high, rugged peaks. Many residents of Vancouver are therefore not aware that there is a volcano closer to the city than the more easily visible Mount Baker in Washington State. Origins
9678_14	Mount Garibaldi began erupting about 250,000 years ago and has grown steadily since then. Like all of the Cascade volcanoes, Mount Garibaldi has its origins in the Cascadia subduction zone—a long convergent plate boundary that stretches from mid-Vancouver Island to Northern California. The subduction zone separates the Juan de Fuca, Explorer, Gorda and North American Plates. Here, the oceanic crust of the Pacific Ocean sinks beneath North America at a rate of per year. Hot magma upwelling above the descending oceanic plate creates volcanoes, and each individual volcano erupts for a few million years.
9678_15	The subduction zone has existed for at least 37 million years, and has created a line of volcanoes called the Cascade Volcanic Arc which stretches over along the subduction zone. Several volcanoes in the arc are potentially active. Lassen Peak in California, which last erupted in 1921, is the southernmost historically active volcano in the arc, while the Mount Meager massif, just north of Mount Garibaldi, which erupted about 2,350 years ago, is generally considered the northernmost. A few isolated volcanic centres northwest of the Mount Meager massif, such as the Silverthrone Caldera, which is a circular wide, deeply dissected caldera complex, are considered by some geologists to be the northernmost member of the arc. Structure
9678_16	Mount Garibaldi is the largest volcano in southernmost British Columbia. Like other stratovolcanoes, it is composed of many layers of hardened lava, tephra, and volcanic ash. Eruptions are explosive in nature, and the most common form is the Peléan style, which involves viscous magma, glowing avalanches of hot volcanic ash and pyroclastic flows. The source magma of this rock is classified as felsic, having high to intermediate levels of silica (as in rhyolite, dacite, or andesite). The tephra deposits have lower volume and range than the corresponding Plinian and Vulcanian eruptions.
9678_17	Mount Garibaldi is known both for the very high quality exposures of its internal structure and for its conspicuous topographic anomalies, which can be attributed to the growth of the mountain onto a large glacier system and the subsequent collapse of the flanks of the volcano with the melting of the ice. The western flanks of the mountain expose basement rocks, sheared and altered quartz diorite, carved by streams and glaciers into a rugged topography with relief up to . Valleys in this jagged surface have been filled with 0.52 to 0.22 million year old dacite and andesite flows, tuff breccias, and domes, precursors of the activity at Mount Garibaldi. About of material remains in the volcano. In modern times, the apron of material around the volcano's main vent extends at least from its source in places that were covered by ice. In other areas its extent is less and its slope is steeper.
9678_18	Stratovolcanoes are a common feature of subduction zones. The magma that forms them arises when water, which is trapped both in hydrated minerals and in the porous basalt rock of the upper oceanic crust, is released into mantle rock of the asthenosphere above the sinking oceanic slab. The release of water from hydrated minerals is termed "dewatering", and occurs at specific pressure/temperature conditions for specific minerals as the plate subducts to lower depths. The water freed from the subducting slab lowers the melting point of the overlying mantle rock, which then undergoes partial melting and rises due to its density relative to the surrounding mantle rock, and pools temporarily at the base of the lithosphere. The magma then rises through the crust, incorporating silica rich crustal rock, leading to a final intermediate composition. When the magma nears the surface it pools in a magma chamber under the volcano. The relatively low pressure of the magma allows water and other
9678_19	volatiles (CO2, S2−, Cl−) dissolved in the magma to begin to come out of solution, much like when a bottle of carbonated water is opened. Once a critical volume of magma and gas accumulates, the obstacle provided by the volcanic cone is overcome, leading to a sudden explosive eruption.
9678_20	Ancestral stages of eruptive activity The mountain grew in three phases. Garibaldi's first phase resulted in the creation of a broad composite cone made of dacite and breccia that has been potassium-argon dated to 250,000 years old. Parts of this "proto-Garibaldi" or ancestral volcano are exposed on Garibaldi's lower northern and eastern flanks and on the upper of Brohm Ridge. Around where Columnar Peak and possibly Glacier Pikes are now located, a series of coalescing dacite lava domes were constructed. During the ensuing long period of dormancy, the Cheekye River cut a deep valley into the cone's western flank that was later filled with a glacier.
9678_21	After reaching its maximum extent the Cheekye Glacier along with part of the area's ice sheet were covered with volcanic ash and fragmented debris from Garibaldi. This period of growth began with the eruption of the Atwell Peak plug dome from a ridge surrounded by the several thousand foot ice sheet. As the plug dome rose, massive sheets of broken lava crumbled as talus down its sides. Numerous Peléan pyroclastic flows (consisting of a super-heated mix of gas, ash, and pumice) accompanied these cooler avalanches, forming a fragmental cone in volume and an overall slope of 12 to 15 degrees. (Erosion has since steepened this slope.) Some of the glacial ice was melted by the eruptions, forming a small lake against Brohm Ridge's southern arm. The volcanic sandstones seen today atop Brohm Ridge were created by ash settling in this lake.
9678_22	Glacial overlap was most significant on the west and somewhat to the south. Subsequent melting of the ice sheet and its component glaciers initiated a series of avalanches and mudflows on Garibaldi's western flank that moved nearly half of the original cone's volume into the Squamish Valley. This series of debris flows carried of the mountain into the Squamish Valley where it covers to a thickness of about . Gaps left by melting ice caused minor to moderate cone distortion where the ice sheet was thin and major distortion where it was thick. The ice was thickest in and thus cone distortion was greatest over the buried Cheekye valley.
9678_23	Soon before or after the buried ice had melted away, dacite lava quietly erupted from Opal Cone southeast of the Atwell Peak plug dome 10,700 to 9,300 years ago and flowed down Ring Creek on Garibaldi's southern and southwestern flanks without encountering any residual glacial ice. One of the lava flows traveled down a 30% to 35% grade over the landslide scar on the western flank. About of dacite erupted in Garibaldi's third period of activity. This lava forms a thin layer of solid rock on the southern and western sides of the volcano and contains well-defined lava flow margin levees. The Ring Creek lava flow is very unusual because lengthy lava flows are usually attained by fluid basalt flows, but the Ring Creek flow is dacite. Current activity
9678_24	Mount Garibaldi is one of the eleven Canadian volcanoes most strongly associated with recent seismic activity; the others are Castle Rock, Mount Edziza, Mount Cayley massif, Hoodoo Mountain, The Volcano, Crow Lagoon, Silverthrone Caldera, Mount Meager massif, Wells Gray-Clearwater Volcanic Field and Nazko Cone. The mountain is informally described as "dormant" ("asleep") because the mountain has not erupted in historic times, nor does it display fumarolic activity like nearby Mount Baker. However, seismic data suggests that these volcanoes still contain living magma plumbing systems, indicating possible future eruptive activity. Although the available data does not allow a clear conclusion, these observations are further indications that some of Canada's volcanoes are potentially active, and that their associated hazards may be significant. The seismic activity correlates both with some of Canada's most youthful volcanoes, and with long-lived volcanic centres with a history of
9678_25	significant explosive behavior, such as Mount Garibaldi. No hot springs are known in the Garibaldi area like those found at the Mount Meager and Mount Cayley massifs, the other major volcanic complexes in the Garibaldi belt, although there are hints of anomalously high local heat flow in Table Meadows and elsewhere.
9678_26	Volcanic hazards
9678_27	Volcanic eruptions in Canada rarely cause fatalities because of their remoteness and low level of activity. The only known fatality due to volcanic activity in Canada occurred at the Tseax Cone in 1775, when a long basaltic lava flow travelled down the Tseax and Nass Rivers, destroying a Nisga'a village and killing approximately 2,000 people by volcanic gases. Many towns and cities near Mount Garibaldi are home to over half of British Columbia's human population, and there is a likelihood that future eruptions will cause damage to populated areas, making Mount Garibaldi and other Garibaldi belt volcanoes a major hazard. There are significant hazards from almost all Canadian volcanoes that require hazard maps and emergency plans. Volcanoes which exhibit significant seismic activity, such as Mount Garibaldi, appear to be most likely to erupt. A significant eruption of any of the Garibaldi belt volcanoes would significantly impact Highway 99 and communities like Pemberton, Whistler and
9678_28	Squamish, and possibly Vancouver.
9678_29	Explosive eruptions
9678_30	Explosive eruptions from Mount Garibaldi would pose a severe threat to the nearby communities of Whistler and Squamish. Although no Plinian eruptions have been identified in Garibaldi's eruptive history, even Peléan eruptions could create large amounts of ash that could significantly affect these local communities. Ash columns may rise to several hundred meters above the volcano, and due to its close proximity to Vancouver this could pose a threat for air traffic. Melting of leftover glacial ice covering the Mount Garibaldi area may cause floods, lahars, or debris flows that could possibly threaten small communities such as Brackendale. Highway 99 is already plagued by landslides and debris flows from the steep rugged Coast Mountains. An eruption creating floods could demolish sections of the highway. Flooding and debris flows could also have severe issues for the salmon fishery on the Squamish, Cheakamus, and Mamquam rivers. In addition, explosive eruptions and the associated ash
9678_31	column could cause short-and long-term water supply difficulties for Vancouver and most of the lower mainland. The catchment area for the Greater Vancouver watershed is close to the Garibaldi area. Pyroclastic fall could also have a deleterious effect on the ice fields to the east of Mount Garibaldi, causing more melting and spring flooding. This in turn could endanger water supplies from Pitt Lake as well as fisheries on the Pitt River.
9678_32	Lava flows The hazard from lava flows would be low to moderate because the nature of the lavas would prevent them from travelling far from their source, even though the Ring Creek lava flow ends only from Squamish. Magma with high to intermediate levels of silica (as in andesite, dacite or rhyolite) commonly move slowly and typically cover small areas to form steep-sided mounds called lava domes. Lava domes often grow by the extrusion of many individual flows less than thick over a period of several months or years. Such flows will overlap one another and typically move less than a few meters per hour. Lava flows with high to intermediate levels of silica rarely extend more than from their source; for example, Garibaldi's long Ring Creek dacite lava flow.
9678_33	Landslides In the past, Garibaldi has had large debris flows. A section of the mountain collapsed into the Cheakamus River valley when the glacier Garibaldi was built on melted, creating a jagged unstable slope at the head of the Cheekye River. Repeated landslides from this steep cliff have created a huge debris fan at the mouth of the Cheekye River just north of Brackendale called the Cheekye Fan. Danger from future collapses have limited the growth of Brackendale onto the fan.
9678_34	The steep northern edge of The Barrier in the Garibaldi area has partly collapsed several times, the most recent being in 1855–56. This collapse created a large boulder field below it, which gave Rubble Creek its name. Danger from future collapses prompted the provincial government to declare the area immediately below it unsafe for human habitation in 1981, effecting the evacuation of the small resort village of Garibaldi nearby, and the relocation of residents to new recreational subdivisions away from the hazard zone. Although imminent danger is unlikely, special regulations exist to warn potential danger and to minimize the risk to life and property in the event of a landslide. Monitoring
9678_35	Currently, Mount Garibaldi is not monitored closely enough by the Geological Survey of Canada to ascertain how active the volcano's magma system is. The existing network of seismographs has been established to monitor tectonic earthquakes and is too far away to provide a good indication of what is happening beneath the mountain. It may sense an increase in activity if the volcano becomes very restless, but this may only provide a warning for a large eruption. It might detect activity only once the volcano has started erupting. A possible way to detect an eruption is studying Garibaldi's geological history since every volcano has its own pattern of behaviour, in terms of its eruption style, magnitude and frequency, so that its future eruption is expected to be similar to its previous eruptions.
9678_36	While there is a likelihood of Canada being critically affected by local or close by volcanic eruptions argues that some kind of improvement program is required. Benefit-cost thoughts are critical to dealing with natural hazards. However, a benefit-cost examination needs correct data about the hazard types, magnitudes and occurrences. These do not exist for volcanoes in British Columbia or elsewhere in Canada in the detail required.
9678_37	Other volcanic techniques, such as hazard mapping, displays a volcano's eruptive history in detail and speculates an understanding of the hazardous activity that could possibly be expected in the future. At present no hazard maps have been created for Mount Garibaldi because the level of knowledge is insufficient due to its remoteness. A large volcanic hazard program has never existed within the Geological Survey of Canada. The majority of information has been collected in a lengthy, separate way from the support of several employees, such as volcanologists and other geologic scientists. Current knowledge is best established at the Mount Meager massif north of Mount Garibaldi and is likely to rise considerably with a temporary mapping and monitoring project. An intensive program classifying infrastructural exposure near all young Canadian volcanoes and quick hazard assessments at each individual volcanic edifice associated with recent seismic activity would be in advance and would
9678_38	produce a quick and productive determination of priority areas for further efforts.
9678_39	The existing network of seismographs to monitor tectonic earthquakes has existed since 1975, although it remained small in population until 1985. Apart from a few short-term seismic monitoring experiments by the Geological Survey of Canada, no volcano monitoring has been accomplished at Mount Garibaldi or at other volcanoes in Canada at a level approaching that in other established countries with historically active volcanoes. Active or restless volcanoes are usually monitored using at least three seismographs all within approximately , and frequently within , for better sensitivity of detection and reduced location errors, particularly for earthquake depth. Such monitoring detects the risk of an eruption, offering a forecasting capability which is important to mitigating volcanic risk. Currently Mount Garibaldi does not have a seismograph closer than . With increasing distance and declining numbers of seismographs used to indicate seismic activity, the prediction capability is
9678_40	reduced because earthquake location accuracy and depth decreases, and the network becomes less accurate. The inaccurate earthquake locations in the Garibaldi Volcanic Belt are a few kilometers, and in more isolated northern regions they are up to . The location magnitude level in the Garibaldi Volcanic Belt is about magnitude 1 to 1.5, and elsewhere it is magnitude 1.5 to 2. At carefully monitored volcanoes both the located and noticed events are recorded and surveyed immediately to improve the understanding of a future eruption. Undetected events are not recorded or surveyed in British Columbia immediately, nor in an easy-to-access process.
9678_41	In countries like Canada it is possible that small precursor earthquake swarms might go undetected, particularly if no events were observed; more significant events in larger swarms would be detected but only a minor subdivision of the swarm events would be complex to clarify them with confidence as volcanic in nature, or even associate them with an individual volcanic edifice. Garibaldi Lake volcanic field
9678_42	Mount Garibaldi is associated with a group of small volcanoes that form the Garibaldi Lake volcanic field. An unusual volcanic structure called The Table is located between Garibaldi Lake and Mount Garibaldi. This several-hundred-foot-high flat-topped volcano is made of layers of andesitic dacite that are arranged like a stack of more or less equal sized pancakes. The Table was formed in the early Holocene at a time when the Cordilleran ice sheet covered the region. As the volcano's lava rose it melted the part of the ice sheet above The Table's vent, creating space for the lava to move into. Repeated eruptions constructed the steep-walled stack of lava seen today. The Black Tusk is a large spire of extensively eroded dark volcanic rock that is shaped like a Walrus tusk. It is considered to be the remnant of an extinct andesitic stratovolcano which formed between about 1.3 and 1.1 million years ago.
9678_43	Mount Price, west of Garibaldi Lake, south of The Black Tusk, was formed in three stages of activity, dating back 1.1 million years, the latest of which produced two large lava flows from Clinker Peak during the early Holocene that ponded against the retreating continental ice sheet and formed The Barrier, containing Garibaldi Lake. Cinder Cone stands above a gap between two arms of Helmet Glacier on Garibaldi's flanks. During summer its crater is filled with a snow melt lake. See also Geology of the Pacific Northwest List of volcanoes in Canada Volcanology of Canada Volcanology of Western Canada References Sources External links Garibaldi Provincial Park at BC Parks
9678_44	Religious places of the indigenous peoples of North America Stratovolcanoes of Canada Two-thousanders of British Columbia Volcanoes of British Columbia Subduction volcanoes Sea-to-Sky Corridor Squamish people Pacific Ranges Sacred mountains Active volcanoes Pleistocene volcanoes Polygenetic volcanoes Garibaldi Lake volcanic field New Westminster Land District
9679_0	A central venous catheter (CVC), also known as a central line, central venous line, or central venous access catheter, is a catheter placed into a large vein. It is a form of venous access. Placement of larger catheters in more centrally located veins is often needed in critically ill patients, or in those requiring prolonged intravenous therapies, for more reliable vascular access. These catheters are commonly placed in veins in the neck (internal jugular vein), chest (subclavian vein or axillary vein), groin (femoral vein), or through veins in the arms (also known as a PICC line, or peripherally inserted central catheters).
9679_1	Central lines are used to administer medication or fluids that are unable to be taken by mouth or would harm a smaller peripheral vein, obtain blood tests (specifically the "central venous oxygen saturation"), administer fluid or blood products for large volume resuscitation, and measure central venous pressure. The catheters used are commonly 15–30 cm in length, made of silicone or polyurethane, and have single or multiple lumens for infusion. Medical uses The following are the major indications for the use of central venous catheters:
9679_2	Difficult peripheral venous access – central venous catheters may be placed when it is difficult to gain or maintain venous access peripherally (e.g. obesity, scarred veins from prior cannulations, agitated patient). Delivery of certain medications or fluids – medications such as vasopressors (e.g., norepinephrine, vasopressin, phenylephrine etc.), chemotherapeutic agents, or hypertonic solutions are damaging to peripheral veins and often require placement of a central line. Additionally, catheters with multiple lumens can facilitate the delivery of several parenteral medications simultaneously. Prolonged intravenous therapies – parenteral medications that must be delivered for extended periods of time (more than a few days) such as long-term parenteral nutrition, or intravenous antibiotics are administered through a central line.
9679_3	Specialized treatment – interventions such as hemodialysis, plasmapheresis, transvenous cardiac pacing, and invasive hemodynamic monitoring (e.g. pulmonary artery catheterization) require central venous access.
9679_4	There are no absolute contraindications to the use of central venous catheters. Relative contraindications include: coagulopathy, trauma or local infection at the placement site, or suspected proximal vascular injury. However, there are risks and complications associated with the placement of central lines, which are addressed below. Complications Central line insertion may cause several complications. The benefit expected from their use should outweigh the risk of those complications.
9679_5	Pneumothorax The incidence of pneumothorax is highest with subclavian vein catheterization due to its anatomic proximity to the apex of the lung. In the case of catheterization of the internal jugular vein, the risk of pneumothorax is minimized by the use of ultrasound guidance. For experienced clinicians, the incidence of pneumothorax is about 1.5–3.1%. The National Institute for Health and Clinical Excellence (UK) and other medical organizations recommend the routine use of ultrasonography to minimize complications.
9679_6	If a pneumothorax is suspected, an upright chest x-ray should be obtained. An upright chest x-ray is preferred because free air will migrate to the apex of the lung, where it is easily visualized. Of course, this is not always possible, particularly in critically ill patients in the intensive care unit. Radiographs obtained in the supine position fail to detect 25–50% of pneumothoraces. Instead, bedside ultrasound is a superior method of detection in those too ill to obtain upright imaging.
9679_7	Vascular perforation Perforation of vasculature by a catheter is a feared and potentially life-threatening complication of central lines. Fortunately, the incidence of these events is exceedingly rare, especially when lines are placed with ultrasound guidance. Accidental cannulation of the carotid artery is a potential complication of placing a central line in the internal jugular vein. This occurs at a rate of approximately 1% when ultrasound guidance is used. However, it has a reported incidence of 0.5–11% when an anatomical approach is used. If the carotid is accidentally cannulated and a catheter is inserted into the artery, the catheter should be left in place and a vascular surgeon should be notified because removing it can be fatal.
9679_8	Catheter-related bloodstream infections All catheters can introduce bacteria into the bloodstream. This can result in serious infections that can be fatal in up to 25% of cases. The problem of central line-associated bloodstream infections (CLABSI) has gained increasing attention in recent years. They cause a great deal of morbidity (harm) and deaths, and increase health care costs. Microbes can gain access to the bloodstream via a central catheter a number of ways. Rarely, they are introduced by contaminated infusions. They might also gain access to the lumen of the catheter through break points such as hubs. However, the method by which most organisms gain access is by migrating along the portion of the catheter tracking through subcutaneous tissue until they reach the portion of the catheter in the vein. Additionally, bacteria present in the blood may attach to the surface of the catheter, transforming it into a focus of infection.
9679_9	If a central line infection is suspected in a person, blood cultures are taken from both the catheter and a vein elsewhere in the body. If the culture from the central line grows bacteria much earlier (>2 hours) than the other vein site, the line is likely infected. Quantitative blood culture is even more accurate, but this method is not widely available.
9679_10	Antibiotics are nearly always given as soon as a patient is suspected to have a catheter-related bloodstream infection. However, this must occur after blood cultures are drawn, otherwise the culprit organism may not be identified. The most common organisms causing these infections are coagulase negative staphylococci such as staphylococcus epidermidis. Infections resulting in bacteremia from Staphylococcus aureus require removal of the catheter and antibiotics. If the catheter is removed without giving antibiotics, 38% of people may still develop endocarditis. Evidence suggests that there may not be any benefit associated with giving antibiotics before a long-term central venous catherter is inserted in cancer patients and this practice may not prevent gram positive catheter-related infections. However, for people who require long-term central venous catheters who are at a higher risk of infection, for example, people with cancer who at are risk of neutropenia due to their
9679_11	chemotherapy treatment or due to the disease, flushing the catheter with a solution containing an antibiotic and heparin may reduce catheter-related infections.
9679_12	In a clinical practice guideline, the American Centers for Disease Control and Prevention recommends against routine culturing of central venous lines upon their removal. The guideline makes several other recommendations to prevent line infections. To prevent infection, stringent cleaning of the catheter insertion site is advised. Povidone-iodine solution is often used for such cleaning, but chlorhexidine appears to be twice as effective as iodine. Routine replacement of lines makes no difference in preventing infection. The CDC makes a myriad of recommendations regarding risk reduction for infection of CVCs, including:
9679_13	The preferred site of insertion (including for non-tunneled catheter placement), from an infection prevention point of view, is in the subclavian vein, and to generally avoid the femoral vein if possible. There is no clear recommendation for a tunneled catheter site in the guidelines. Selection of catheters should include those with minimal ports to accomplish the clinical goal. Sterile gloves are required for CVC Full body sterile drapes, cap, mask, gloves are required for placement of CVCs The catheter site should be monitored visually and with palpation (through dressing) on a regular basis to assess for infection. It is, however, acceptable to use clean, non-sterile, gloves for changing the dressing of intravascular catheters. Both chlorhexidine and povidone-iodine are acceptable skin cleansers, though chlorhexidine is preferred. For short-term CVC sites, dressings must be changed at least every 7 days for transparent dressings, and every 2 days for gauze dressings.
9679_14	For long-term implanted or tunneled catheters, dressings are to be changed no more than once weekly unless soiled or loose. Routine removal and replacement of a central venous catheter is not recommended. While central line catheters should be removed as soon as they are no longer necessary, scheduled removal and replacement, whether over a guidewire or with a new puncture site, has not been shown to be beneficial in preventing infections. Medication impregnated dressing products can reduce the risk getting catheter-related blood stream infection. There is inconclusive evidence whether longer interval of changing dressings for central venous access devices is associated with more or less infections. It is unclear whether cleaning the skin antiseptics or without skin cleansing can reduce the rate of catheter-related bloodstream infections.
9679_15	Occlusion Venous catheters may occasionally become occluded by kinks in the catheter, backwash of blood into the catheter leading to thrombosis, or infusion of insoluble materials that form precipitates. However, thrombosis is the most common cause of central line occlusion, occurring in up to 25% of catheters .
9679_16	CVCs are a risk factor for forming blood clots (venous thrombosis) including upper extremity deep vein thrombosis. It is thought this risk stems from activation of clotting substances in the blood by trauma to the vein during placement. The risk of blood clots is higher in a person with cancer, as cancer is also a risk factor for blood clots. As many as two thirds of cancer patients with central lines show evidence of catheter-associated thrombosis. However, most cases (more than 95%) of catheter-associated thrombosis go undetected. Most symptomatic cases are seen with placement of femoral vein catheters (3.4%) or peripherally inserted central catheters (3%). Anti-clotting drugs such as heparin and fondaparinux have been shown to decrease the incidence of blood clots, specifically deep vein thrombosis, in a person with cancer with central lines. Additionally, studies suggest that short term use of CVCs in the subclavian vein is less likely to be associated with blood clots than CVCs
9679_17	placed in the femoral vein in non-cancer patients.
9679_18	In the case of non-thrombotic occlusion (e.g. formation of precipitates), dilute acid can be used to restore patency to the catheter. A solution of 0.1N hydrochloric acid is commonly used. Infusates that contain a significant amount of lipids such as total parenteral nutrition (TPN) or propofol are also prone to occlusion over time. In this setting, patency can often be restored by infusing a small amount of 70% ethanol. Misplacement CVC misplacement is more common when the anatomy of the person is different or difficult due to injury or past surgery.
9679_19	CVCs can be mistakenly placed in an artery during insertion (for example, the carotid artery or vertebral artery when placed in the neck or common femoral artery when placed in the groin). This error can be quickly identified by special tubing that can show the pressure of the catheter (arteries have a higher pressure than veins). In addition, sending blood samples for acidity, oxygen, and carbon dioxide content (pH, pO2, pCO2 respectively) can show the characteristics of an artery (higher pH/pO2, lower pCO2) or vein (lower pH/pO2, higher pCO2). During subclavian vein central line placement, the catheter can be accidentally pushed into the internal jugular vein on the same side instead of the superior vena cava. A chest x-ray is performed after insertion to rule out this possibility. The tip of the catheter can also be misdirected into the contralateral (opposite side) subclavian vein in the neck, rather than into the superior vena cava.
9679_20	Venous air embolism Entry of air into venous circulation has the potential to cause a venous air embolism. This is a rare complication of CVC placement – however, it can be lethal. The volume and the rate of air entry determine the effect an air embolus will have on a patient. This process can become fatal when at least 200–300 milliliters of air is introduced within a few seconds. The consequences of this include: acute embolic stroke (from air that passes through a patent foramen ovale), pulmonary edema, and acute right heart failure (from trapped air in the right ventricle) which can lead to cardiogenic shock.
9679_21	The clinical presentation of a venous air embolism may be silent. In those who are symptomatic, the most common symptoms are sudden-onset shortness of breath and cough. If the presentation is severe, the patient may become rapidly hypotensive and have an altered level of consciousness due to cardiogenic shock. Symptoms of an acute stroke may also be seen. Echocardiography can be used to visualize air that has become trapped in the chambers of the heart. If a large air embolism is suspected, a syringe can be attached to the catheter cap and pulled pack in an attempt to remove the air from circulation. The patient can also be placed in the left lateral decubitus position. It is thought that this position helps relieve air that has become trapped in the right ventricle.
9679_22	Catheter-related thrombosis Catheter-related thrombosis, or CRT, is the development of a blood clot related to long-term use of CVCs. It mostly occurs in the upper extremities and can lead to further complications, such as pulmonary embolism, post-thrombotic syndrome, and vascular compromise. Symptoms include pain, tenderness to palpation, swelling, edema, warmth, erythema, and development of collateral vessels in the surrounding area. Most CRTs are asymptomatic, and prior catheter infections increase the risk for developing a CRT. Interventions include routine flushing with positive pressure and repositioning. Treatment requires anticoagulant therapy and possible removal of the CVC. Insertion
9679_23	Before insertion, the patient is first assessed by reviewing relevant labs and indication for CVC placement, in order to minimize risks and complications of the procedure. Next, the area of skin over the planned insertion site is cleaned. A local anesthetic is applied if necessary. The location of the vein is identified by landmarks or with the use of a small ultrasound device. A hollow needle is advanced through the skin until blood is aspirated. The color of the blood and the rate of its flow help distinguish it from arterial blood (suggesting that an artery has been accidentally punctured). Within North American and Europe, ultrasound use now represents the gold standard for central venous access and skills, with diminishing use of landmark techniques. Recent evidence shows that ultrasound-guidance for subclavian vein catheterization leads to a reduction in adverse events.
9679_24	The line is then inserted using the Seldinger technique: a blunt guidewire is passed through the needle, then the needle is removed. A dilating device may be passed over the guidewire to expand the tract. Finally, the central line itself is then passed over the guidewire, which is then removed. All the lumens of the line are aspirated (to ensure that they are all positioned inside the vein) and flushed with either saline or heparin. A chest X-ray may be performed afterwards to confirm that the line is positioned inside the superior vena cava and no pneumothorax was caused inadvertently. On anteroposterior X-rays, a catheter tip between 55 and 29 mm below the level of the carina is regarded as acceptable placement. Electromagnetic tracking can be used to verify tip placement and provide guidance during insertion, obviating the need for the X-ray afterwards. Catheter flow
9679_25	Hagen–Poiseuille equation The Hagen–Poiseuille equation describes the properties of flow through a rigid tube. The equation is shown below: The equation shows that flow rate (Q) through a rigid tube is a function of the inner radius (r), the length of the tube (L), and the viscosity of the fluid (μ). The flow is directly related the fourth power of the inner radius of the tube, and inversely related to the length of the tube and viscosity of the fluid. This equation can be used to understand the following vital observations regarding venous catheters: that the inner radius of a catheter has a much greater impact on flow rate than catheter length or fluid viscosity, and that for rapid infusion, a shorter, large bore catheter is optimal because it will provide the greatest flow rate. Types There are several types of central venous catheters; these can be further subdivided by site (where the catheter is inserted into the body) as well as the specific type of catheter used. By site
9679_26	Percutaneous central venous catheter (CVC) A percutaneous central venous catheter, or CVC, is inserted directly through the skin. The internal or external jugular, subclavian, or femoral vein is used. It is most commonly used in critically ill patients. The CVC can be used for days to weeks, and the patient must remain in the hospital. It is usually held in place with sutures or a manufactured securement device. Commonly used catheters include Quinton catheters. Peripherally inserted central catheters (PICC)
9679_27	A peripherally inserted central catheter, or PICC line (pronounced "pick"), is a central venous catheter inserted into a vein in the arm (via the basilic or cephalic veins) rather than a vein in the neck or chest. The basilic vein is usually a better target for cannulation than the cephalic vein because it is larger and runs a straighter course through the arm. The tip of the catheter is positioned in the superior vena cava. PICC lines are smaller in diameter than central lines since they are inserted in smaller peripheral veins, and they are much longer than central venous catheters (50–70 cm vs. 15–30 cm). Therefore, the rate of fluid flow through PICC lines is considerably slower than central lines, rendering them unsuitable for rapid, large volume fluid resuscitation. PICCs can easily occlude and may not be used with dilantin IV.
9679_28	However, PICC lines are desirable for several reasons. They can provide venous access for up to one year. The patient may go home with a PICC. They avoid the complications of central line placement (e.g. pneumothorax, accidental arterial cannulation), and they are relatively easy to place under ultrasound guidance and cause less discomfort than central lines. PICC lines may be inserted at the bedside, in a home or radiology setting. It is held in place with sutures or a manufactured securement device. Subcutaneous or tunnelled central venous catheter
9679_29	Tunneled catheters are passed under the skin from the insertion site to a separate exit site. The catheter and its attachments emerge from underneath the skin. The exit site is typically located in the chest, making the access ports less visible than catheters that protrude directly from the neck. Passing the catheter under the skin helps to prevent infection and provides stability. Insertion is a surgical procedure, in which the catheter is tunnelled subcutaneously under the skin in the chest area before it enters the SVC. Commonly used tunneled catheters include Hickman, and Groshong, or Broviac catheters and may be referred to by these names as well. A tunnelled catheter may remain inserted for months to years. These CVCs have a low infection rate due to a Dacron cuff, an antimicrobial cuff surrounding the catheter near the entry site, which is coated in antimicrobial solution and holds the catheter in place after two to three weeks of insertion.
9679_30	Implanted central venous catheter (ICVC, port a cath)
9679_31	An implanted central venous catheter, also called a port a cath or port a catheter, is similar to a tunneled catheter, but is left entirely under the skin and is accessible via a port . Medicines are injected through the skin into the catheter. Some implanted ports contain a small reservoir that can be refilled in the same way. After being filled, the reservoir slowly releases the medicine into the bloodstream. Surgically implanted infusion ports are placed below the clavicle (infraclavicular fossa), with the catheter threaded into the heart (right atrium) through a large vein. Once implanted, the port is accessed via a "gripper" non-coring Huber-tipped needle (PowerLoc is one brand, common sizes are length; 19 and 20 gauge. The needle assembly includes a short length of tubing and cannula) inserted directly through the skin. The clinician and patient may elect to apply a topical anesthetic before accessing the port. Ports can be used for medications, chemotherapy, and blood
9679_32	sampling. As ports are located completely under the skin, they are easier to maintain and have a lower risk of infection than CVC or PICC catheters.
9679_33	An implanted port is less obtrusive than a tunneled catheter or PICC line, requires little daily care, and has less impact on the patient's day-to-day activities. Port access requires specialized equipment and training.
9679_34	Ports are typically used on patients requiring periodic venous access over an extended course of therapy, then flushed regularly until surgically removed. If venous access is required on a frequent basis over a short period, a catheter having external access is more commonly used. Catheter types
9679_35	Triple-lumen catheter The most commonly used catheter for central venous access is the triple lumen catheter. They are preferred (particularly in the ICU) for their three infusion channels that allow for multiple therapies to be administered simultaneously. They are sized using the French scale, with the 7 French size commonly used in adults. These catheters typically have one 16 gauge channel and two 18 gauge channels. Contrary to the French scale, the larger the gauge number, the smaller the catheter diameter. Although these catheters possess one 16 gauge port, the flow is considerably slower than one would expect through a 16 gauge peripheral IV due to the longer length of the central venous catheter (see section on "catheter flow" above). It is important to note that the use of multiple infusion channels does not increase the risk of catheter-related blood stream infections.

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