Has anyone had experince with greater than one Powerglide midline? I was just informed that our cardiac surgeorn is adverse to using PICC's, with a preference to Midlines (Powerglide). His CRNP requested a second , and the IV nurse complied.
1. Would there be any rationale to not have more than one?
2. Is there any protocol/procedure that that would be different/recommended.
I have not seen this practice in the past.
Thank you in advance.
There are numerous clinical situations where 2 peripheral catheters are needed for incompatible medications. The same could be true for a midline. There are dual lumen midlines available however there are no studies reporting outcomes of dual lumen midlines and most experts think it is not wise to use these. A midline is never going to replace a central line and a PICC is a central line. Not sure what issue your cardiac surgeon has with PICCs but there are certainly patients that must have some type of central line and a midline is not going to be acceptable to infuse what is required.
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
As always, thank you for your expert advice!
Bobbi Price MSN, RN
We do this on a semi-frequent basis. This is generally on patients that require more than one IV site due to incompatibilties. We have had no complications to date from such practice.
M.K.
ICU Nurse
RN, PHRN, VA-BC, NRP
Lynn this is what is happening across the board with PICC usage. Because of the financial "spanking" hospitals take for CLABSI , it's become a stategy to use the MIdline often and without regard to the innate problems that catheter can have.There are countless situations where a PICC would be the appropriate line , but managers are strongly discouraged by upper management to use anything but a central catheter. No central catheter....no CLABSI problem. Sounds logical, at the least from a financial standpoint but what they are turning their backs on is what it means to the patient. I have seen first hand what the damage from improper venous access can do, and have written countless Patient Safety reports as instructed, but to no avail. Finally, I left because it was just too much.
Oh yes, I realize this, but these practices are the exact opposite of what they should be doing. Finally CDC has realized these unintended consequences of this public policy and are looking at some changes. The comment period was over in April but they are looking at revising the definitions of HAI and including all VADs in these definitions. Once that is done, then CMS can look at this financial problem that drives use of inappropriate VADs.
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
It's about time. I often thought .."I wish that all lines were included in reports"...now you say they are considering it....that is great news
Our hospital is having us covert picc lines to mid lines before they leave ICU. Problem is many end up back in ICU within 24 hrs and then they want it converted back to a picc. Pta are getting mult lines just to avoid a CLABSI. This is management driven. Our Team thinks this is wrong. It increases DVT and infection risks. Not to mention financial costs and mult pt procedure. How do we fight administration?
That midline that started out as a PICC will be counted as a CLABSI if bloodstream infection occurs. So this is a bogus method to avoid CLABSI. And with all that excess manipulation, the chances of that site producing a CLABSI are great. Involve infection prevention - they know the criteria for counting CLABSI. Also take this to risk management. Finally refuse to do it. This is not in the best interest of patients. If your efforts fail, I would say NO to doing this.
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
managers and epidemiology nurse are the ones pushing this. I feel it is poor patient care
Sounds like you have a lot of education to do. Your infection prevention staff must be informed about how to count CLABSI as they clearly do not understand that the change from a PICC to a midline will not prevent that original PICC from being counted as a CLABSI. Read the INS SOP on Catheter Damage which includes exchange.
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 Lynn