We have had a couple of midlines removed by home care due to the lack of blood return, yet the line flushes in well. What is the standard in situations like this when one knows the midline is correctly in place, flushes easily, and there is no sign of infection?
No blood return means there is a problem. It may be technique or a complication but something is not right. Use small syringe, very slow gentle method to aspirate. If possible put a tourniquet above tip to see if this changes outcome. Flushing alone does not tell you all you need to know about patency. Is tip too far and actually in shoulder? What vein as used? Is there thrombus at tip? The standard of practice is to get a blood return on all vads before using it. Lynn
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
What I have discovered is when they dont give blood return it is becasue we have collapsed the line. Its usually somewhere around 10mm so its short. Most often you can move the arm whatever you can do to make the catheter not be sucked shut at the end and then you will get blood.
Cheryl Ferraro RN, CRNI
I agree with Cheryl, often a gentle pull with a small syringe will give a good return, and tourniquets often seem to be the problem. We have to learn to use these devices, they do have a few quirks.
According to INS Standards, all venous access devices require a blood return before any therapy. If no blood return, device should be removed.
a.k.a. Vascular Access Specialist
Blood return adds another significant component to the patency assessment of all VADs. No blood return could be a technique issue such as pulling too hard and fast on the syringe plunger rod especially with a 10 mL syringe. It could also be a problem with vein thrombus/inflammation at the catheter tip. You simply cannot tell by looking and palpating. I would change to a smaller syringe and use very slow and gentle technique to aspirate before removing it though. Lynn
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
imaPICCRN2, so you would pull a device that had a partial occlusion that could be treated and patency restored with Alteplase?
What if the patient had no access and that was their only remaining device?
Timothy R. Spencer, RN, APN, DipAppSci, BH, ICU Cert, VA-BC™
That CVC guy from Australia :-}
Using Alteplase to declot a Midline would be off label use. Alteplase (Cathflo) is only intended for central lines.
Jean Mathews BSN,RN,CRNI