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Angela Williams
power midlines

Okay, no groaning now I have to ask. What do these experts think of cutting a power injectable PICC  to 20 cm and using for pressure injectable tests like CT with PE protocol? We have a pulmonary doc who orders these tests on probably 90% of his patients and alot of them do not have a place for a 20gauge 2 inches above the wrist as dictated by radiology. If you can safely inject in the forearm, why not place a more comfortable line in for a couple of days of steroids and daily IV antibiotic.? Your comments are appreciated


Ann Earhart
power midlines
The contrast they use for PE's has an osmolosity of 671 and is injected at 4ml/second, which works out to be greater than 10,000ml/hour.   You can check with BARD, but I  don't believe  they indicate their power PICC for use as a midline. /This would be an off label use.   I work in Radiology and see infiltrated arms from contrast.   Many of the contrast infiltrates need a surgical consult.   No way will I want to deal with infiltrated contrast in the axilla.   The arm is bad enough.   The osmolality is too great for a midline according to INS stanards, not to mention the power injection.   Feel free to contact me off line.   I have a power point presentation on contrast.  
Kathleen Witt
Power Midlines
Since the Power PICC actually is stamped with the label "Power PICC" on the hub, I would not want to use it for a Midline. It can very easily be confused as being a PICC and the wrong infusates given through it. When we first started using them this happened, and a pt actually got TPN through a Power PICC that had been cut to Midline length prior to the pt being started on TPN. When we have pts that just need a CT scan and steroids/IVFs, we either place the Power PICC or just a PIV.
power midline

If the dye used is isotonic and there are many out there than I see no problem with using a peripheral catheter for a power injection.   I totally hate the idea of using a peripheral catheter for a hyperosmolar dye to begin with.   I think all facilities should bite the bullet in cost  and go to the isotonic dyes.   I would not suggest using any midline tip for a power injection with a hyper-osmolar drug.  

 That being said unfortunately:

The cutting of a PICC line to do a midline for power injection  is off label   Wish I could say it was not off label


Kathy Kokotis

Bard Access Systems

Laura Cook CRNI
I would never use a midline
I would never use a midline for a power injection.   The veins may not stand up to the power injection.   These veins are also  much deeper than the superficial veins in the forearm.   Much more contrast would be injected before an infiltration could be visibly detected.   Even more's off label use.   if a  messy situation were to's your back side that would be hung.
nancy riley
use of power piccs - turned midlines

Hi Angela,

  I have to admit I have been using the power picc as a midline for power injection on a limited and case by case basis.   I feel it is much safer than a peripheral IV.   I had a recent patient who had an iv placed for ct, the pvl got dislodged and 250mls of CT solution infiltrated into the patients arm.   She wound up with a sever burn with blistering and sloughing of tissue.   She is an extremely difficult iv start.   I place all of our midlines at the axillary vein and we have had great success.   While I recognize it is off label use; it is in a vein with a larger diameter and better flow rate than the peripheral iv.  

Nancy Riley, RN, CRNI

power mid-lines
sounds risky to me. CT contrast is a vesicant. we wouldn't put any vesicants through a mid-line. why not go the extra 20cm and make it a picc. if you wanted to avoid the x-ray, have the rad doc watch a test dose injection to assure that it is infusing in the svc.   this also goes back to the question of using u/s to place angio caths for ct when veins cannot be found.
Richard Johnson
midlines for injection

Our radiology department says that for PE studies that the IV has to be at least a 20g preferably a 18g. in the anticubital area. You can not do pressure studies via injection from a forearm vein. Because of problems with dislogged catheters, we usually place 1 3/4 in 18g iv catheters in the a/c or basilic vein.

It seems that if a vein can hold up to a IV catheter is should hold up to a Midline injection. My concern about the use of midlines is not the vein,but the catheter holding up under pressure... I am speaking of regular midlines, not trimmed power injectable picc lines.  

Is there some contraindication about injection at the level of the axilla--other than extravisation.

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