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We place so few midlines lately that Ican honestly say I don't remember the last one I did. However, we used... i guess we still use the BD 4f silcone midcath. They come a standard 20cm, and we would insert into the ac the full 20cm. Most importantly, I would say to measure from your insertion site shoulder and cut if nessecary. the tip of the cath needs to be peripheral, that is not to extend into the subclavian vein. I think if I had a case that called for a midline now, I would use ultrasound and access the low to mid basilic and measure and cut to the axillea.

The correct method is to place the tip of a midline catheter level with the patient axilla, distal to the shoulder. This will remain in either the basilic or cephalic veins since the axillary vein begins at the lateral edge of the chest, which is past the point where the midline tip should be allow to remain. This requires patient measurement and inserting only the exact length needed. Lynn

We insert quite a few midlines at our hospital and most of them above the ac using US.  We frequently trim them to ensure the tip does not pass the pt's axilla.  We try not to trim much shorter than 15cm, otherwise you may have problems removing your introducer without losing your access.  If necessary, we trim at 15cm, then even leave a bit of the line out 1-2 cm if need be, just to make sure we haven't passed the axilla.