we've been told that it is ok to use a midline for 5fu that will run continuously at home on ambulatory pump for 5 weeks.Â
i have never given chemo like this on anything less than central line. i also foresee problems with blood return on bag change
each week. any recommendations?
I would strongly recommend NOT using a midline for continuous infusion of 5fu. It is a vesicant, and there are plenty of case studies discussing the serious problems r/t 5fu extravasation. Extravasation with a midline would very likely be much worse than an extravasation with a peripheral because the tip is deeper in the tissue and near brachial plexus/branches leading to the plexus.
Also, there is not enough blood flow which increases risk of phlebitis/thrombophlebitis.
Search this forum for "midline" and I think you'll find some helpful discussion.
FYI - Check out this abstract about left sided approach central catheter terminating in the upper SVC....
Hickman Catheter Perforation of the Superior vena Cava with 5-FU Extravasation into the Anterior Mediastinum A Case ReportHickman catheter perforation of the superior vena cava with erosion of the catheter tip into soft tissues and extravasation of 5-fluorouracil into the anterior mediastinum is reported. Symptoms included progressive hoarseness and inter mittent right chest pain. Chest x-ray revealed migration of the catheter tip out of the vessel and extravasation of fluid. Risk factors for this complication in clude left subclavian vein cannulation, positioning of the catheter tip in the upper portion of the superior vena cava, and impingement of the catheter tip against the vessel wall. Good catheter position should be confirmed and tenting of the lateral wall of the superior vena cava excluded by careful examination of a postinsertional chest x-ray.
Vascular and Endovascular Surgery, Vol. 24, No. 6, 443-447 (1990)
Mari Cordes, BS RN
Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center