Forum topic

 Are you placing a Powerglide as a midline in the corkrect midline tip location or are you placing them in the forearm? A midline tip location is too deep in the tissue to easily detect an extravasation and it is not recommended according to the INS Standards of Practice. If you are using these 3 inch catheters in the forearm, the need for a longer catheter is usually driven by the veins lying deep in the tissue. AGain it would be most difficult to detect extravasation early. Additionally, midlines are famous for failing to produce a blood return, something that is needed for all VADs but especially for vesicant infusion before and during the infusion. Lynn

 I almost didn't reply to this. We place powerglides, mainly in the upper arm, occasionally will do a forearm (like < 1/month). We adamantly stress that these are peripheral lines and are governed by our peripheral IV policy. TWICE (!) in the last month I have come in the morning and a patient was receiving TPN (not PPN or clinimix, no it sure was D70W!) in their upper arm powerglide. head-into-wall, CRNI/VABC full blown panic mode, etc. Both patients were ok, still gave blood return, PICCs placed without incident, unusual occurrence reports entered. Staff reported not knowing that TPN was a vesicant. I will never recommend a midline for continuous infusion of a vesicant, and decline to insert when this is the planned therapy/speak about CVC/PICC or place PIV. But we often use these for intermittent or IVP vesicants without thinking about it - IV contrast? D50W? Unfortunately, I've had MDs order 1 time doses of 3%NS given over 5-6 hours, and staff just gave it through the powerglide already in place. As inserter, we can only assess the intended therapy when we place, which in an acute care facility often changes after we place the device. As the nurse administering the med, we need to properly assess the access device before, during, and after the infusions we give. 

Kathleen Crowe BSN RN CRNI VABC