Hi Team,
My question is how does the "new" dwell times for devices, or saying a device should dwell as long as it is asymtomatic, affect your device selection for long term administration of infusates that are well infused peripherally, such as rocephin? Or cefazolin? In the past, and currently, I try to place midlines for infusions less than or equal to 4 weeks and PICCs for greater than four weeks. In my practice, this has worked well for my patient population. However, I have been questioning this seeing the newer recommendations to leave VAD in place until sypmotmatic. Has anyone had success infusing infusates well tolerated peripherally through midlines for greater than 4 weeks? Does the IFU for a product over-rule the site assessment? In the past, I've even replaced a perfectly functioning midline for a patient whose ABX was extended past the initial proposed duration thinking the line would "expire." Now I think that may have been unnessecary?
Thank you kindly.
Kate
First and foremost, there is no maximum or optimum dwell time for ANY VAD, including midlines. Some, but not all brands, use the 29 days to influence dwell time, however that number does not establish the maximum dwell time in any way. Actually, the is the FDA's method to categorize VADs into short term (less than 30 days) and long term groups. FDA does not use the words "dwell" or "dwell time" in any way. All VADs should be removed when there is a clinical indication for removal or at the end of therapy. There is absolutely no reason to remove any VAD that is functioning correctly without and signs or symptoms of any complication due to some arbitrary number of days. There is no clinical studies supporting this 29 day language. There are numerous locations that are seeing midline dwell times longer than 29 days. Do you have the INS Standards of Practice? If not you need to obtain this document to guide your practice. Also the MAGIC guidelines are now recognized as the most appropriate method for guiding decisions on VAD planning. Here is that reference and you can now find a MAGIC app to use for these decisions. 1.Chopra V, Flanders SA, Saint S, Woller S, O'Grady NP, N S. The Michigan appropriateness guidel for intravenous catheers (MAGIC). Ann Intern Med. 2015;163:S1-S39.
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