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Midlines vs PICC lines: a question from a (future) patient


FIrst, I want to thank you in advance for reading this post. I am not a medical professional. I do know, however, that if you want the real scoop, you ask the folks who have the right info. From what I've read, the folks in this forum will have the answers I'm seeking.

I just returned from seeing an Infectious Disease physician, who has determined that I will require IV Rocephin to treat my Lyme disease. He mentioned both midlines and PICC lines. My understanding is that midlines are not as long-lasting as PICC lines. He also mentioned that a midline could be placed by a home health nurse in my home. I don't care if I have to go to the hospital to get whichever type of line placed. I just don't want to end up having this done TWICE.

Would it be to my benefit to request the PICC line (instead of a midline)? THe plan is to start on 28 days of 2grams / day of Rocephin, and then re-evaluate. From what I've read from other patients' experiences, 28 days is often insufficient, and many end up recieving IV antibiotics for at least a few months.

If you have a moment, could you tell me a bit about the procedure, and about the benefits of a mid vs a PICC line? I'm a real pansy when it comes to pain, but a little info can go a LONG way in assuaging my fears.


Again, thanks in advance for any words of wisdom you can provide.


Michele in NJ


p.s. "Home Solutions" is the agency my doc mentioned (i.e., Dr. DeShaw in Morristown, NJ)


I am a strong supporter of

I am a strong supporter of using midlines because I wrote the original training programs and instructions for the first midline catheter sold in the US. But I don't think that a midline is the right catheter for your needs. Midlines are indicated for therapies that will be needed for 1 to 4 weeks. There is a great likelihood that you will need therapy longer than 4 weeks, so I would recommend a PICC. 

A midline is about 6 inches long and the tip terminates in the upper portion of your arm, level with your arm pit. A PICC terminates in the large vein immediately before your heart. The major difference is the vein diameter and the amount of blood flow through those veins. The tip of the PICC is positioned in a much larger vein than the midline, causing less vein irritation, more blood to rapidly dilute the medication, and can be used for longer periods.

The insertion procedures are similar. A midline can be performed in the home because a chest xray is not needed. A chest xray to confirm the correct tip location of a PICC is needed. There are a couple of different insertion procedures but both use local anesthetic  agents to decrease the pain from the stick.

What activities will you be doing while the catheter is in place? If your work calls for use of your arms, a PICC placed in the middle of your upper arm would be preferred. An ultrasound machine is used to locate the vein. A midline placed by home care is usually inserted in a large vein that can be easily seen and felt in the bend of your arm. This location can be a problem with arm activities. The catheter can migrate outward due to arm movement. If it were me or one of my family members, I would want a PICC. Good luck with your treatment. Lynn 

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

Thanks so much for your

Thanks so much for your throughtful and speedy response!

I phoned the infusion company to ask a few questions. As it turns out, they already had my name, and the order from Dr. DeShaw for a midline. She was very kind and very helpful (not unlike you folks!). I asked if she could phone the doc and request the PICC in lieu of it. She said she would phone the doc and get back to me.

I care for 2 children during the day (working as a nanny for the time being). Although I don't have to use my arms constantly, I am doing laundry and hauling backpacks and that sort of thing.

It sure sounds like the PICC is the way to go.

Thanks again for your kind and informative post.



p.s. What sort of time frame for placement am I looking at here? Could I have it placed in the morning and then be back to pick up the kids at the bustop at 3:30? Should I slate out an entire day? What do you think?

p.p.s. Are you, by chance, familiar with the treatment of Lyme disease? In your experience, am I likely looking at 3+ months of IV rocephin, or might a month or two do the trick ( I was likely infected about 2 years ago, had a seizure, etc, but was officially diagnosed about 4 months ago...current sxs include pain, stiffness, and some cognitive issues)

Michele- re Original post:


re Original post: If it's done right,the worst thing about the whole procedure will be having a snug tourniquet on your arm for a few minutes. Since the procedure does involve a needle to get access to the vein,it will involve a "stick" but most practitioners use lidocaine or something similar---like getting a Novocaine shot before dental work--to minimize the discomfort.

re ps: Talk to the place that will place your line but it shouldn't be over 90 minutes,most of which is waiting around.

re pps: Probably too close to giving medical advice for us. Good question for the MD,though.

Good luck.

Hi Michele-As it happens, I

Hi Michele-As it happens, I am the Director of Nursing for Home Solutions-the agency which will provide services to you at your physician's request.  I concur with the advice given to you above and would like for you to call me in my office at this number-888-646-6379x122.  I would certainly welcome the opportunity to answer any questions that you may have and to further discuss the options for your therapy. 

I will look forward to speaking with you!  Carol Sweeney CRNI

Carol Sweeney, CRNI, Vice President of Nursing & Clinical Compliance  ContinuumRx

Thanks, Carol!   I will

Thanks, Carol!


I will definitely give you a call mid-morning.


Thanks again to all who responded.




p.s. Carol, the person from your agency, Mala, who answered my call was VERy helpful, very kind, and encouraging. Just thought you should know :) 

Heather Nichols
Michele,     Just saw


    Just saw your posting and wanted to say good luck with your treatment.  The advice your have already received is sound, so I have nothing to add except that I have had two PICC's in the past, one for 5 months, and I am a full time nurse.  I had no problem working (or playing for that matter, I ride horses) with either one.  The procedures were painless both times I had them placed.  Do not be afraid.


THanks so much to all who

THanks so much to all who replied.

My PICC line was placed on Thursday, and it was pretty easy, as you said!

The nurses arrived Friday to train me how to adminster the Rocephin. Unfortunately, I had a seizure 10 minutes after the first dose (not sure why that happened, but it was a bit disconcerting, I must say!). I'm being switched to Zithromax now.

Again, thanks so much for the encouraging words and helpful, accurate info.



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