A few months ago, I went through all published evidence for midlines. This data is included in evidence tables in my online CE course on Midline Catheters. There are no published studies on dual lumen midlines at all. So there are no evidence based outcomes that could be generalized to other facilities or populations.
The facility that I work at is considering a dual lumen midline and the only question we had before we move forward is if there is any information on if you can infuse incompatible medications through the dual lumen considering it is not located in a central vessel. Would this be ok to do? If not we don't feel like a dual lumen would benefit us. Thank you in advance.
There is no evidence to provide the answer to your question.. Given the vast difference in volume of blood flow at the midline tip location and the SVC, IMHO I would say no to infusion of incompatibile medications through a dual lumen midline. A midline was never intended to totally replace a CVAD.
we tried double lumen. In theory, a D/L midline is a great solution. Then you get that argument about incompatible solutions . It's 2 seperate lines. The tip exits in the axilla. Why do nurses believe that two incombatible solutions exiting at the same time, immediately entering into a fast moving blood stream, somehow mix IN that blood and explode?. If that was the case, shouldnt we also look at two seperate peripherals in the same arm and the distance between them, to be sure the the meds don't mix at some point and cause a reaction?...and if so, what is that distance. Please will the nurse that came up with THAT theory enter this conversation and explain how that happens?
We used the Arrow double lumen MST-placed Midlines for several years and now only use the single lumen. Based on data we collected, thrombosis occured more frequently with the use of the double lumens, from the medial exit port specifically. We discharge patients with these midlines for IV therapy < 4 weeks. Inpatients will get Extended-dwell PIVs in the forearm to preserve the upper arm veins for possible PICC placements.
Possible Reasons:
Larger 5.5F french size compared to the 4.5F single lumen
Location of the medial exit port - IV infusion could be causing irritation to the vessel wall compared to a distal lumen IV infusion
Tips from experience:
Single lumen MST-placed Midline which gave us an average of 14 days blood sampling and higher IV therapy completion rate compared to the double lumen. Longest dwell time was 65 days.
Measure tip placement 1-2cm below the axillary line
Do not trim catheter tip
Use anti-reflux connector to maintain catheter patency
Lynn, Has there been any movement, data collection, orresearch that support or not the use of Dual Lumen Midlines & the infusion of incompatable medications at this time
Answer your own question. I assume you have been a nurse for a while, so, wouldn't you rather have 2 lines instead of one. I mean as a clinician. A midline catheter has limited advantages in average conditions anyway. So, I'm not in the camp that Midlines are the save all lines.But you have the advantage of 2 IV's. The incompatible solution arguement doesnt hold much water when you drill down that evidence. It's based on mostly "nurse beliefs".
Whether incompatibles mix and crystalize with concurrent delivery in the blood supply might be hard to determine but the fact is the human body is a container and metabolites of these incompatibles must be managed in that container. We also can't say what is happening in the excretion of these metabolites, efficacy of the infusates, or the impact of one infusate on the other within the human container. These are pharmaceutical questions and really (!) hard to chase down, but should be considered. If possible, don't infuse concurrent or in rapid succession. I wouldn't provide a dual lumen when it isn't warrented to protect an unknowing nurse from hurting a patient. Lots to consider once we begin to examine this.
I have searched for years about dual lumen midlines. In the mid 90's one facility required that we place dual lumen midlines. I was totally against it and refused to go to that facility. That is when I sought information on dual lumen midlines and nover found any and still have not. Makes sense to me that where the tip is positioned for a midline that there is not enough hemodilution to use a dual. The other issue I had with them is, so many nurses see a dual lumen and say, oh a PICC so I can give anything through this line and have tried to give two meds at once not knowing if they are compatible. I believe that a dual lumen midline takes up too much space in the vein for where the tip placement is hence less hemodilution factor. Wish that I could find research on this issue but there is none that I'm aware of. Common sense tells me it isn't a good idea, but nothing out there to back that up. I see so many nurses that can't tell me the difference between a PICC and a midline and that tells me that they don't know that a midline is a peripheral IV and a PICC is a Central. So many of the antibiotics that we give IV today are phlebogenic and with the tip of a midline at the level of the axilla, if the midline is in the basilic vein you won't know if the patient has a chemical phlebitis unless the patient complains of burning during infusion, and where I placed midlines fore years most of the patients were confused. Even when confused I would ask the patient, why did you pull your IV out and they would say, "It hurts". All of this is only my opinion and wish there was literature out there to confirm it. I started placing mildlines back it the Landmark midline days. Warren Willard
Blood flow rate through the axilla is 250ml/minute. That's pretty fast. so a solution coming from one lumen and an incompatible solution coming from a lumen right beside it. Entering a moving system at 250ml/min or 4ml/sec. just doesn't seem possible to cause a problem. Has anyone ever heard of a problem??
A few months ago, I went through all published evidence for midlines. This data is included in evidence tables in my online CE course on Midline Catheters. There are no published studies on dual lumen midlines at all. So there are no evidence based outcomes that could be generalized to other facilities or populations.
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
Hello Lynn,
The facility that I work at is considering a dual lumen midline and the only question we had before we move forward is if there is any information on if you can infuse incompatible medications through the dual lumen considering it is not located in a central vessel. Would this be ok to do? If not we don't feel like a dual lumen would benefit us. Thank you in advance.
Thank You,
Chelsea
Chelsea Gavere, RN
There is no evidence to provide the answer to your question.. Given the vast difference in volume of blood flow at the midline tip location and the SVC, IMHO I would say no to infusion of incompatibile medications through a dual lumen midline. A midline was never intended to totally replace a CVAD.
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
Ken,
we tried double lumen. In theory, a D/L midline is a great solution. Then you get that argument about incompatible solutions . It's 2 seperate lines. The tip exits in the axilla. Why do nurses believe that two incombatible solutions exiting at the same time, immediately entering into a fast moving blood stream, somehow mix IN that blood and explode?. If that was the case, shouldnt we also look at two seperate peripherals in the same arm and the distance between them, to be sure the the meds don't mix at some point and cause a reaction?...and if so, what is that distance. Please will the nurse that came up with THAT theory enter this conversation and explain how that happens?
We used the Arrow double lumen MST-placed Midlines for several years and now only use the single lumen. Based on data we collected, thrombosis occured more frequently with the use of the double lumens, from the medial exit port specifically. We discharge patients with these midlines for IV therapy < 4 weeks. Inpatients will get Extended-dwell PIVs in the forearm to preserve the upper arm veins for possible PICC placements.
Possible Reasons:
Tips from experience:
Lynn, Has there been any movement, data collection, orresearch that support or not the use of Dual Lumen Midlines & the infusion of incompatable medications at this time
Timothy McCrory, RN, BSN, CCRN, VA-BC
I have not seen any studies on double lumen midlines. My last literature search was probably a couple of years ago.
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
Tim,
Answer your own question. I assume you have been a nurse for a while, so, wouldn't you rather have 2 lines instead of one. I mean as a clinician. A midline catheter has limited advantages in average conditions anyway. So, I'm not in the camp that Midlines are the save all lines.But you have the advantage of 2 IV's. The incompatible solution arguement doesnt hold much water when you drill down that evidence. It's based on mostly "nurse beliefs".
Whether incompatibles mix and crystalize with concurrent delivery in the blood supply might be hard to determine but the fact is the human body is a container and metabolites of these incompatibles must be managed in that container. We also can't say what is happening in the excretion of these metabolites, efficacy of the infusates, or the impact of one infusate on the other within the human container. These are pharmaceutical questions and really (!) hard to chase down, but should be considered. If possible, don't infuse concurrent or in rapid succession. I wouldn't provide a dual lumen when it isn't warrented to protect an unknowing nurse from hurting a patient. Lots to consider once we begin to examine this.
I have searched for years about dual lumen midlines. In the mid 90's one facility required that we place dual lumen midlines. I was totally against it and refused to go to that facility. That is when I sought information on dual lumen midlines and nover found any and still have not. Makes sense to me that where the tip is positioned for a midline that there is not enough hemodilution to use a dual. The other issue I had with them is, so many nurses see a dual lumen and say, oh a PICC so I can give anything through this line and have tried to give two meds at once not knowing if they are compatible. I believe that a dual lumen midline takes up too much space in the vein for where the tip placement is hence less hemodilution factor. Wish that I could find research on this issue but there is none that I'm aware of. Common sense tells me it isn't a good idea, but nothing out there to back that up. I see so many nurses that can't tell me the difference between a PICC and a midline and that tells me that they don't know that a midline is a peripheral IV and a PICC is a Central. So many of the antibiotics that we give IV today are phlebogenic and with the tip of a midline at the level of the axilla, if the midline is in the basilic vein you won't know if the patient has a chemical phlebitis unless the patient complains of burning during infusion, and where I placed midlines fore years most of the patients were confused. Even when confused I would ask the patient, why did you pull your IV out and they would say, "It hurts". All of this is only my opinion and wish there was literature out there to confirm it. I started placing mildlines back it the Landmark midline days. Warren Willard
Blood flow rate through the axilla is 250ml/minute. That's pretty fast. so a solution coming from one lumen and an incompatible solution coming from a lumen right beside it. Entering a moving system at 250ml/min or 4ml/sec. just doesn't seem possible to cause a problem. Has anyone ever heard of a problem??