My facility places traditional, trimmable BARD Power Midlines but we will start using Power Glides as well. My confusion lies with the fact that both products are labeled midlines, but there are distinct differences; for example, sterile vs. non-sterile insertion. The term midline is defined by INS as "a catheter inserted into the upper arm via the basilic, cephalic, or brachial vein, with the internal tip located level at or near the level of the axilla and distal to the shoulder." The Power Glide IFU states that the device may be inserted in the upper or lower arm, so does it still fit the true definition of a midline?
ALL VADs are defined by tip location. A midline tip location is as you stated from the INS Standards. You may use a device labeled as a midline, but the only way you will have a midline tip location is to place the device to reach the correct tip location you have seen from INS. Any tip location short of that would be a long term dwell PIV and NOT a midline. I know this is confusing but always think of VADs by where the tip terminates. Some patients, bariatrics, etc, may need a longer length catheter to reach their deep peripheral veins in the forearm and that is a good use of these devices, however it is not a midline tip location. Given the fact that the same infusates can go through by a PIV and a midline, making this difference between these two tip locations may be unnecessary. All VADs should now be removed based on clinical indications, another factor that removes differences between a PIV and a midline. But if you are intending to get long dwell times from any VAD, PIV or midline, you need complete sterile technique for them all.
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
Thank you for the explanation. If we use the power glide as a long term dwell piv, how does that work legally if the product is labeled midline?
I don't see how that could ever be an issue. Instructions for use state it can be placed in the veins of the arm. Also FDA does not have a separate defnition of a midline catheter - either it is peripheral or central. A midline is always going to be in a peirpheral vein. 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
Thank you again, for your helpful information. One last post: I will not be using the term 'midline' to describe the PG, so does the product need to be replaced in 29 days? I know that the PG doesn't 'expire' at 29 days; if it is functioning without any signs of complications, it can be left in. I just need to define the duration of dwell time in policy - 29 days or 96 hours? (we will be going clinically indicated soon). Also, patients with 'midlines' may be discharged from my hospital with them indwelling. Again, because I will be using this product as a PIV, I assume that patients may not be discharged with them. Thanks again!
29 days is NOT a dwell time. 96 hours no longer applies. All VADs, all types are removed based on clinical indications. See INS Standard on VAD Removal. 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
Lynn
Just a quick question to clarify. The INS standard is for "ALL" VAD? Is central line access included in this? I know we need to discontinue Cnetral access as soon as we can for infection issues, but does site condition apply for central access devices?
Thank you
Kathy
Yes, all VADs means every type of catheter both peripheral and central. There are no maximum or optimum dwell time known for any VAD and no recommendations to remove them at any specific point in time. All are removed when therapy is complete and when there is a clinical indication for removal.
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