Our facility is considering adding midlines to our vascular access options. I am wondering what others who insert/use them think?
Thank you in advance!
1. What product does your facility use? Satisfaction?
2. Do you have a separate consent for midline placement?
3. Are labs successfully drawn from midlines?
4. Does your facility use saline flush only or SASH?
5. Issues???
The most important aspect of successfully using midline catheters is to make appropriate choices for the types of therapy that can be infused through a midline. They should never be regarded as a substitute for a CVAD. If the pH is above 9 or below 5 and/or the osmolarity above 600, then a CVAD is indicated and a midline or a peripheral are appropriate. I have seen many hospitals who did not follow these guidelines, had many complications with midlines and placed all the blame on the catheter. There must a a serious amount of critical thinking and patient evaluation when choosing the most appropriate vascular access device for all patients and this definitely applies to midlines. So if there are managers who have misguided ideas about using a midline to reduce the number of CVADs, you need to correct there thinking immediately. See Infusion Nursing Standards of Practice in numerous standards referring to midlines. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Thank you Lynn...we are considering adding midlines for our facility and are definitely aware of the staff and physician education that MUST precede and continue post implememtation. Midlines appear to be a valuable option when used appropriately.
Keely Ralston RN-BC, VA-BC, CPUI, RCIS
1. We use Med-Comp or Arrow/Teleflex. Either one is an open-ended, 20cm, polyurethane, tube. Pt. satisfaction has not been an issue.
2. Every facility we go to has a different policy for Midlines, they either require a signed informed consent, as with a PICC or they don't. Either way we require a form of assent from the patient/leagally authorized representative before proceding.
3. Labs can be drawn from Midlines. Success is often based on the amount of fibrin built up on the catheter. What to do after that happens is a completely different thread on IV-Therapy.Net
4. It is an open-ended tube... the access cap and ability of the nurses has more to do with whether a facility requires heparin locking or not.
5. Issues... What Lynn said. The biggest problem with Midlines is that they are used as a short-cut or substitute for CVADs. Use them for peripheral infusates only and the outcomes will improve. Use them improperly and you will injure the patient and potentially block future attempts for PICC placement.
Mickey
Michelle L. Hawes, RN, MSN, CRNI, VA-BC
Chief Executive Officer
Vascular Access Specialists, LLC
Indianapolis, IN
317-888-0303