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Why aren't midline catheters used more often?

 I'm an undergraduate student at UIC doing my senior design project on designing an IV catheter targeted toward pediatric patients. I know the infection rate is high for short PIV's, and low for midline catheters. So my question is, why are midline catheters used so infrequently? What are the disadvantages?

Also, what are some typical midline catheters that are used? Do they typically expand after you insert them? Please outline the way that they work for me. We're trying to design an expandable one so you nurses don't have the catheter flopping all over the place while you try to thread it into the vein. Was the Landmark midline catheter expandable? Also, what's the likelihood of reintroduction of the Aquavene since it was found that the material wasn't what was causing the infections?

Thanks for your help.

I think you have some of your

I think you have some of your facts confused. Short peripheral catheters have an extremely low rate of bloodstream infection - 0.1% has been reported - however the number of catheter sold is ~330 million. This would mean that even a very low rate would produce a very high absolute number of BSIs. The only figure for a rate of BSI associated with midlines is 0.8 events per 1000 catheter days. Infection is not the problem with midlines. Midlines have been used incorrectly by many facilities thinking that they can replace a CVAD. This is grossly wrong! Midlines replace repeated peripheral catheter insertions but can never replace a CVAD. So outcomes of severe thrombophlebitis have occured when the fluids infused were extremely hypertonic or were of an irritant or vesicant nature.

All PICC manufacturers offer a midline that is a short version of their PICC, inserted by MST or a traditional through the introducer method. These are all made of polyurethane or silicone. There is no longer any cateter material that expands on the market. I was employed by the company that designed, developed and manufactuered the Landmark catheter, helped to write all the instructions of use, and conducted huge amounts of training and education on this catheter. I was also directly involved with the events that led to J&J removing it from the market. I will be happy to discuss this with you over the phone. I don't have time to write answers to all your questions in this forum. Please call me at 770-358-7861, ext. 2#. I will be available on Monday, 10-31 after 3:30 pm ET, all day on Tuesday, Nov 1. I hope that will work with your schedule. Lynn

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

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

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