I am curious if anyone is placing midlines without max. barrier and if so, what are the conditions? We are investigating the midline options. I have one company telling me the midline is encased (you never touch it directly) , so they state you don't need max barrier. The other company says max barrier is required as the cath is exposed.
If anyone has any thoughts/experiences/data to share, I would appreciate it.
Thanks,
Kathleen
We do use maximum barrier for the insertion of our midlines to maintain consistency across the board and because of the intended dwell time for the midline even though it is a peripheral device. I am not familiar with an encased midline but I don't know how that would matter since it is about environmental control and not just control over catheter sterility.
The very first midline brand on the US market was also encased in a protective sheath. I wrote much of the content for how to use that device and we emphasized strict sterile technique, however that was before we began to use max barriers for PICCs. I am not aware of any studies showing evidence for max barriers for midline insertions, but I would strongly agree that they are needed. The insertion site, procedure, and dwell times for a midline is very close to that of a PICC, so it only makes sense to me to use max barriers. Lynn
Lynn Hadaway, M.Ed., RN, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
I remmeber well the Landmark catheter but I'm not aware of any new encased devices. Can you tell us which company makes this catheter, Kathleen
I don't remember the name of the catheter or company but I have seen it at INS. I think the company is from Israel but it is on the US market. Lynn
Lynn Hadaway, M.Ed., RN, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Angela,
Bard has the Powerglide, which they explain the cath is encased, not ever exposed. I have not used this.
Thanks,
Kathleen
Kathleen Wilson, CRNI
Lynn and others can you please give a definition for "Midline" [generally NOT power injectable] vs "Extended Dwell" [generally power injectable]
and the patient that would be a candidate for each--Is the industry using these terms interchangably?
Is a Midline defined by the length of the catheter or the tip location?
Thank You
Robbin George RN VA-BC
The INS standards define midline catheter as a vascular access device measuring 8 inches or less with the distal tip dwelling in the basilic, cephalic, or brachial vein, at or below the level of the axilla and distal to the shoulder. There are now 2 brands of midline catheters that are labeled as power injectable catheters. The tip location is more important than the device length.
Extended dwell is a term mainly used for marketing purposes that includes all catheters that dwell for long periods. There is no definition of what this period actually is though. The FDA has 2 categories of catheters - those intended for less than 30 days of use and those intended for greater than 30 days of use, however this does not allow the manufacturer to provide recommendations about how long a specific catheter should remain indwelling. This term does not define a specific type of catheter. Extended beyond what? Beyond a regular short peripheral? Now there is no specific time limit on the dwell time for a short PIV cath, so that does not apply.
See the INS standards for the types of therapies that can be infused through a midline device, but basically there is no difference between a midline and PIV when it comes to the pH, osmolarity and vesicant/irritant nature of the drugs. Same parameters apply.
I would not use those terms interchangeably. Lynn
Lynn Hadaway, M.Ed., RN, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
So for purposes of communicating with staff as regards care and maintenance we could essentially call an "Extended Dwell" catheter [approx 4.5 inches long] placed in the upper arm a "Midline"--Is this correct?
And as regards "Max Barrier" for insertion of these catheters are you saying that this would require a full body drape for the patient and hat mask and sterile gown for the operator? OR would some modified version--for example the same barrier precautions we use for sterile dressing change--be acceptable?
Robbin George RN VA-BC
It would be a midline catheter if you have achieved the tip location I described. If this is not the tip location, it would be a regular peripheral catheter but then 4.5 inches as a peripheral catheter would not meet the standard of the smallest and shortest length of catheter in the vein. For a midline insertion, I would use max barriers. There is no evidence that you can safely use less. Of course there are no studies showing that max barriers are necessary either for a midline, but I would err on the side of safety and use max barriers. Lynn
Lynn Hadaway, M.Ed., RN, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Below are 2 examples of Midline/Extended Dwell catheters
http://www.neomedicalinc.com/content/frequently-asked-questions-about-extended-dwell-piv
http://bardaccess.com/midline-powerglide.php?section=Video
Even though The BARD product has the word "Midline" in it's name according to Lynn's definition if you placed it in the forearm it would be an extended dwell device
Robbin George RN VA-BC
There is no category of catheters defined by any professional organization - nursing or medical - that states you can place a long catheter of any design into a peripheral vein and allow it to dwell for extended periods of time. Extended dwell is mainly a marketing term, It is NOT a clinical term. See INS SOP for types of catheters or categories of VADs. Extended dwell is not use. Lynn
Lynn Hadaway, M.Ed., RN, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Critical thinking question---If you personally were to have a catheter left in place for 3 weeks and 2 days, no matter where the tip lies, would you want the line placed using Maximum barrier precautions?
You should treat your patients with the same respect and care you would want for yourself.
Chris Cavanaugh, RN, BSN, CRNI, VA-BC
I looked at the video for Bard's midline. It's interesting that the video demonstrates placement in the forearm which would not allow the tip to be at the level of the axilla. Also, the entire device looks very convoluted and mechanical...perhaps a big learning curve. I would be interested in opinions of those that may be using or have trialed it.
Good Morning Everyone,
I agree with Lynn regarding dwell time, and vessel selection are the important device selection criteria.
Midlines- We use nursing full procedure trays for midlines or picc line insertions, to include gown, and head cover. We are trialing the powerglide midline right now with mixed results. We are however utilizing sterile probe cover, gown, and provided kit contents for the insertions. Assessment continues.
Alfonza J. Riley, RN,RVS