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Kristine Selck
Neonatal PICC/midlines

Does anyone have any experience with the Neonatal population "outgrowing" their PICC lines? Lines placed in Neonates that have their tips in the SVC on placement, but the baby grows over time and the tip naturally migrates out of the SVC and may end up as a midline. The lines are in well over 28 days, if anyone else has any experience with this do you have policies in place to assure central concentrations are not given? Also, are there any specific processes for pediatric midlines to detect infiltration other than arm measurement. Pediatric drips may run in at a very slow rate and detection could be very delayed.
Thank you,
Kristi Selck, RN BSN
UF Health/Shands Hospital

lynncrni
 Midline or midclavicular tip

 Midline or midclavicular tip location with growth? I am having a hard time envisioning growth in a month to lead to a midline tip location in the upper arm level with the axilla, which is a midline tip location. High in the SVC or innominate or maybe subclavian vein which is a midclavicular tip location, I can see that. 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

Kristine Selck
I was told that after several

I was told that after several months that they have had some make it to axilla area. Even if they are just mid-clavicular wouldn't that technically still be considered Midline? It wouldn't be considered central.

We are developing a midline policy.  Do any other institutions restrict midline placement to a patient that's been afebrile for 48 hours?

Thank you,

Kristi

lynncrni
 Midline and midclavicular

 Midline and midclavicular are 2 distinctly different tip locations. Midline - basiilic or cephalic or brachial vein, level with the axilla and distal to the shoulder - is an acceptable tip location with supporting evidence. Midclavicular is somewhere in the area of proximal axillary vein (not the axilla), subclavian, innominate and is not supported by any evidence whatsoever. There is a study from later1990's and an old AVA position paper opposing midclavicular tip location and this has never been recognized as an acceptable tip location in the INS standards of practice. 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

Kristine Selck
 What would you suggest in

 What would you suggest in this case then?  They put the lines in and leave them in for months, the babies grow and he tip position changes.  I don't think we could talk them into removing the lines.  I'm not sure how to respond to the inquiry as to whether this is acceptable or not.  

 

We are developing a midline policy.  Do any other institutions restrict midline placement to a patient that's been afebrile for 48 hours?

Thank you,

Kristi

lynncrni
 A periodic evaluation is

 A periodic evaluation is required to determine when the tip is malpositioned for any reason. This would be a secondary malposition and it must be corrected. When it is due to growth, the catheter should be removed and a new one inserted if infusion therapy is needed. An evaluation would include the continued necessity for infusion, ability to eat/drink, acuity, etc. It simply can not be ignored as a tip high in the SVC is known to produce increased risk of addition tip migration, vessel erosion, vein thrombosis, etc. 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

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