We have a few questions regarding midlines. We are planning to use them only as a last resort unable to place any other access. First does anyone get a consent to place them? Our manager would like us to still get a consent. Second do you measure daily arm circumference or just initially and then if there is a problem. Thank you.
I personally think that midlines have much greater use than as a last resort. They are considered a peripheral catheter and I have never worked where a consent for insertion was required. Daily midarm circumference is not recommended as there is no evidence to support this practice. Get a baseline and then repeat if there are any signs and symptoms of complications. Also carefully choose the patients you will place these in. A midline is a substitute for repeated peripheral venipunctures but if there are indications for a central line (pH, osmolarity, vesicants, etc) a midline will not solve your problems. In fact using a midline when a CVC is indicated will increase your problems. When properly chosen, a midline will work well but it requires a careful assessment of all factors.
Lynn Hadaway, M.Ed., RN, BC, CRNI
www.hadawayassociates.com
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
We have recently had a home infusion patient with a midline placed in the lower part of the arm receiving 2 gm Rocephin BID. Insertion site is 4 inches above the WRIST. Developed redness and tenderness below the antecubital area (assumed catheter tip location) after two doses. Spoke to director of outpatient facility that placed the midline and questioned choice of insertion site and was told that that is "okay"...doesn't the site they chose for insertion defeat the purpose of placing a midline in the first place?? How do I educate this facility on the appropriate placement of midlines? We don't want our homecare patients having midlines in their lower arms!!!!
This is not a midline catheter, regardless of what was marked on the external catheter. They may have used a midline catheter incorrectly but the catheter tip for a midline is located in the upper arm, distal to the shoulder, level with the armpit in either the baslilc or cephalic vein. Regardless of what any physician said, this would be managed as any other short peripheral catheter and would never fall under the recommendations for a midline catheter.
Lynn Hadaway, M.Ed., RN, BC, CRNI
www.hadawayassociates.com
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