yes we have been using the Powerglide for over 4 months but mainly placing them in the upper arms as low as possible. We have had then in place up to 3 weeks. I know that there is discussion about placing in the lower arm, about 2 inches below the antecubital, but I am concerned. Point is, at times a regular PIV inserted near the antecubitalarea has problems with valves and veins having extra collateral deviations, thus unable to thread the short PIV catheter. With the Powerglide being 3-4 inches we are worried about passing through the antecubital, thus we have preferred the straighter and larger veins of the upper arms.
When we use the Powerglide, patients have already been stuck numerous times thus we want to just place the
Thanks Tracy. I am thinking about using them the same way; as a midline. Do you restrict what meds can be infused through them? I'm worried about things like vanco causing deep phlebitis.
PowerGlide and PowerWand are midline catheters and they should not be used for drugs like vancomycin for 2 reasons. Vanco is a vesicant and will always have a pH below 4. See INS Standards for this criteria for what can and can not be infused through a midline catheter. Lynn
I look for my vein, mark it, prep with chloraprep, then inject with lidocaine 1%. Then I put my sterile gloves on and proceed to set up my field. I use a brachial angiography drape. One thing that I've found with the powerglide is that the guidewire is too short and needs to be floppier at the tip. I think it's difficult when you have to use a steeper angle of insertion, when the guidewire is deployed it gets stuck in the back wall. I've heard of other people using it that have expressed this concern. I spoke with one of our Bard nurse educators and she said the company is aware and are going to be implementing some changes to the guidewire over this next year. Patients are liking the product because of the length of dwell, not having to get poked repeatedly. Something I've found very helpful when the catheter gets stuck or kinks during insertion is I pull everything out of it....needle, guidwire, etc. I pull the cath back to where its giving me a good blood return. I thread a nitinol wire through the catheter into the vessell and proceed to thread the catheter the rest of the way in. It has worked beautifully. But you must put some sterile gauze underneath the catheter so that it's not laying across the skin while you're getting your wire ready.
Ann Armstrong, RN
Ann Armstrong, RN
PICC Lines
MidMichigan Medical Center, Midland
I appreciate your comments regarding the shortness of the Powerglide wire as it confirms the same concern I have voiced to my BARD rep at every oppportunity
I will take your advise regarding the wire to the bedside and use it the next time I insert the Powerglide
This seems like a very expensive midline to me, especially if you need to add a nitinol wire to get it placed. Why not just place a basic midline if that is what your patient needs? Midline kits are much less expensinve.
Sorry I am late in entering this conversation. We have been using this device for about 4 months. We find the guidwire is fine. Where our inserters lose it initially when learning is in the movement to advance the gudiewire and the catheter. If there is any wiggle or movement it is easy to come out of the vein. New learners seem to find it hard to thread the wire and then the catheter without exchanging the placement of their hands somehow. Too muchmanipulation will definaltely hurt you on this device. Patients love it. We are not happy with the securement device in the kit and have spoken out strongly with Bard about it.
Why are we considering this 8-10cm catheter a midline? The definition of the midline is tip near the auxilla with a catheter 8-20cm long. The midline according to INS guidlines are for medications with pH between 5 and 9, and meds with osmolarity no greater than 600, and yet this "midline" is FDA approved for Contrast, which has osmolarity 650 and greater, with the common ones around 850.....The catheter withstands the power injector for psi, but what about the osmolarity of the medications. While BARD and the FDA is calling this a midline, is this really a midline or a long peripheral??
If this is a long IV, then Cochrane review supports leaving in IV's until no longer patent. Food for thought in this discussion.
INS Standards also call for the shortest length of catheter. So PowerGlide and PowerWand would not be considered a "long peripheral catheter" as there is no such category and I do not believe there should be such a category. The FDA does not "approve" devices as this infers some level of clinical performance. Devices are "cleared for market" meeting they are substantially equivalent to a predicate device, or a device that is already on the market. I would consider these to be only indicated for a midline tip location. I do agree that there is a problem with using them for high osmolarity contrast agents. But they are designed to accommodate the psi. That does not mean there would be positive clinical outcomes with their use for contrast. Studies are needed - 'show me the data". Lynn
I am worried about using them for pressure injection. Even though the device can handle the psi due to the manufacturing, the risk for infiltration and extravasation are so high due to the tip position. I don't understand what has changed and makes these ok to pressure inject into and not traditional midline catheters when we know the risks?
For those of you that are using them...... How long does the blood return really last? And what measures have you taken in your policy to decrease the risks with the CT contrast extravasation? Do any of you require blood return prior to pressure injection, on top of the other obvious sign of checking for patency and vascular status like flushing, leaking, swelling, redness, and pain?
Just a reminder that the American College of Radiology Manual on Contrast includes checking for a blood return before using a catheter for contrast injection. So this is not dependent upon the type of catheter being used.
Also, remember that the FDA clears these devices for market without requiring a huge number of actual clinical studies, although I think there was some level of clinical data required for these catheters. You should check with the device manufacturers for that information. There has not been a lot published about their outcomes yet. Lynn
Hi Rick,
yes we have been using the Powerglide for over 4 months but mainly placing them in the upper arms as low as possible. We have had then in place up to 3 weeks. I know that there is discussion about placing in the lower arm, about 2 inches below the antecubital, but I am concerned. Point is, at times a regular PIV inserted near the antecubitalarea has problems with valves and veins having extra collateral deviations, thus unable to thread the short PIV catheter. With the Powerglide being 3-4 inches we are worried about passing through the antecubital, thus we have preferred the straighter and larger veins of the upper arms.
When we use the Powerglide, patients have already been stuck numerous times thus we want to just place the
Powerglide with just one stick.
Tracy W. Ivory, RN, BSN, CRNI, VA-BC
Faxton-St. Lukes Healthcare
Thanks Tracy. I am thinking about using them the same way; as a midline. Do you restrict what meds can be infused through them? I'm worried about things like vanco causing deep phlebitis.
Rick
Richard Simpson RN, CCRN
PowerGlide and PowerWand are midline catheters and they should not be used for drugs like vancomycin for 2 reasons. Vanco is a vesicant and will always have a pH below 4. See INS Standards for this criteria for what can and can not be infused through a midline catheter. 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
Those of your inserting the PowerGlide, how much draping do you use? What is your prep?
Darla Tarvin RN VA-BC
Mercy Clermont Hospital
Hi Rick,
I look for my vein, mark it, prep with chloraprep, then inject with lidocaine 1%. Then I put my sterile gloves on and proceed to set up my field. I use a brachial angiography drape. One thing that I've found with the powerglide is that the guidewire is too short and needs to be floppier at the tip. I think it's difficult when you have to use a steeper angle of insertion, when the guidewire is deployed it gets stuck in the back wall. I've heard of other people using it that have expressed this concern. I spoke with one of our Bard nurse educators and she said the company is aware and are going to be implementing some changes to the guidewire over this next year. Patients are liking the product because of the length of dwell, not having to get poked repeatedly. Something I've found very helpful when the catheter gets stuck or kinks during insertion is I pull everything out of it....needle, guidwire, etc. I pull the cath back to where its giving me a good blood return. I thread a nitinol wire through the catheter into the vessell and proceed to thread the catheter the rest of the way in. It has worked beautifully. But you must put some sterile gauze underneath the catheter so that it's not laying across the skin while you're getting your wire ready.
Ann Armstrong, RN
Ann Armstrong, RN
PICC Lines
MidMichigan Medical Center, Midland
ANN
I appreciate your comments regarding the shortness of the Powerglide wire as it confirms the same concern I have voiced to my BARD rep at every oppportunity
I will take your advise regarding the wire to the bedside and use it the next time I insert the Powerglide
Thank You
Robbin George RN VA-BC
This seems like a very expensive midline to me, especially if you need to add a nitinol wire to get it placed. Why not just place a basic midline if that is what your patient needs? Midline kits are much less expensinve.
Chris Cavanaugh, RN, BSN, CRNI, VA-BC
Sorry I am late in entering this conversation. We have been using this device for about 4 months. We find the guidwire is fine. Where our inserters lose it initially when learning is in the movement to advance the gudiewire and the catheter. If there is any wiggle or movement it is easy to come out of the vein. New learners seem to find it hard to thread the wire and then the catheter without exchanging the placement of their hands somehow. Too muchmanipulation will definaltely hurt you on this device. Patients love it. We are not happy with the securement device in the kit and have spoken out strongly with Bard about it.
Jose Delp RN BSN VA-BC
My questions to the group:
Why are we considering this 8-10cm catheter a midline? The definition of the midline is tip near the auxilla with a catheter 8-20cm long. The midline according to INS guidlines are for medications with pH between 5 and 9, and meds with osmolarity no greater than 600, and yet this "midline" is FDA approved for Contrast, which has osmolarity 650 and greater, with the common ones around 850.....The catheter withstands the power injector for psi, but what about the osmolarity of the medications. While BARD and the FDA is calling this a midline, is this really a midline or a long peripheral??
If this is a long IV, then Cochrane review supports leaving in IV's until no longer patent. Food for thought in this discussion.
INS Standards also call for the shortest length of catheter. So PowerGlide and PowerWand would not be considered a "long peripheral catheter" as there is no such category and I do not believe there should be such a category. The FDA does not "approve" devices as this infers some level of clinical performance. Devices are "cleared for market" meeting they are substantially equivalent to a predicate device, or a device that is already on the market. I would consider these to be only indicated for a midline tip location. I do agree that there is a problem with using them for high osmolarity contrast agents. But they are designed to accommodate the psi. That does not mean there would be positive clinical outcomes with their use for contrast. Studies are needed - 'show me the data". 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
I am worried about using them for pressure injection. Even though the device can handle the psi due to the manufacturing, the risk for infiltration and extravasation are so high due to the tip position. I don't understand what has changed and makes these ok to pressure inject into and not traditional midline catheters when we know the risks?
For those of you that are using them...... How long does the blood return really last? And what measures have you taken in your policy to decrease the risks with the CT contrast extravasation? Do any of you require blood return prior to pressure injection, on top of the other obvious sign of checking for patency and vascular status like flushing, leaking, swelling, redness, and pain?
Just a reminder that the American College of Radiology Manual on Contrast includes checking for a blood return before using a catheter for contrast injection. So this is not dependent upon the type of catheter being used.
Also, remember that the FDA clears these devices for market without requiring a huge number of actual clinical studies, although I think there was some level of clinical data required for these catheters. You should check with the device manufacturers for that information. There has not been a lot published about their outcomes yet. 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
I have a feeling this isn't always being done, that is my fear. Thanks Lynn for your reply.
I think you are right!! 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