I need to get an impromptu consensus of how many facilities will still use a Midline catheter that does not have a blood return. I know the Standards of Practice state a blood return must be obtained in all VAD's prior to infusion of medications. The lack of a blood return indicates to me that there is already a change in the vein. However, there are many nurses that will still use a line if it infuses well regardless of the lack of a blood return. Since Cathflo cannot be used on a peripheral IV or Midline catheter, are those lines being removed and replaced?? At my facility it is not unusual for a Midline catheter to not have a blood return after a short time. Is anyone using a specific brand that they have more reliable blood return from??
Kelly Rolfsen RN, CRNI
Franciscan Health Indianapolis
Lack of a blood return on a Midline catheter may be indicative of many different ongoing processes. It does not necessarily indicate that vein physiology changes are occuring. For example use of a large volume syringe to aspirate blood may collapse the catheter on itself thus preventing blood return. The tip of the Midline catheter may abut the vein wall and upon aspiration pull the tunica intima into the syringe thereby preventing blood return. At my hospital we encourage nurses to always flush first with 10cc of normal saline and then replace the syringe with a 3cc or 5cc syringe to aspirate blood for discard and use the same size syringe to pull blood for labs. We have recently changed to Angiodynamics BioFlo Midline catheters. We are having good results with blood draws from this particular brand although no guarantees are expected. A recent trend that I've encountered is leaking of fluid from the Midline site. We did a Doppler on our last Midline with this problem and discovered an axillary DVT. Unable to know if the DVT was present prior to the Midline or not. But back to your question re use of a Midline without a blood return...my hospital is very large and I doubt that our busy nurses are checking for a blood return prior to using the Midline. This practice occurs more frequently than not despite the fact that INS standards are being ignored.
Glad to hear that the biomimetic properties of the BioFlo is producing good results with blood returns. Also switching to a smaller syringe for aspiration is a great step. I also think technique has a lot to do with success with checking for a blood return. I also think that if technique changes fail, there is a great chance that there is some pathophysiology going on. A tip against a vein wall will disrupt the endothelial layer of the tunica intima, exposing the basement membrane to blood and beginning the thrombus process. Since checking for a blood return is a standard of practice, it is one aspect of assessing the care provided when reviewing medical records in a lawsuit. Many nurses will scoot by without doing this part of a complete VAD assessment, but you never know when a bad outcome will lead to being named in a lawsuit and it will be staff nurse giving the med that bears the liability for a lack of assessment before giving the med. 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