Forum topic

 Just yesterday I completed a new online course on midline catheters which involved a literature search. I did not find any studies that assessed drawing blood samples from any midline catheter. There is a problem with a lack of blood return after several days with midlines. Also, the prevailing thought now is that an assessment should be done for each patient on the risk vs benefits for using any catheter to draw blood samples due to the increased manipulation of the catheter hub and risk of contamination. Sorry, but I did not find any evidence either way on using midlines for blood sampling. Lynn

Lynn,

Thanks for the update on research with midlines.  Our hospital is currently inserting midlines once a week on the patients who are having bariatric surgery.  The program has just started.  We are tracking if the patient has a blood return for their short length of stay (3-4 days).  We noted that 3 of the first 7 midlines inserted did not yield a blood return after 48 hours-72 hours.  We will continue to keep track and do a chart review for infusions, medications, lab draws, etc., as well as patient complications of (symptomatic) thrombus formation or developing a PE post-op.  We are doing this for the first 40 patients (ordered 40 midlines!) as anecdotal information.  If there is a large percentage that do not have a blood return or develop complications, we are going to approach the surgeon about placing PICCs and comparing. 

To DJDempsy:  we are allowing our hospital staff to draw from the line because the purpose of placing these in the bariatric patient was due to difficulty keeping an IV in and the lab obtaining samples without difficulty.  However, we see this is not always the case.

Carole

Blood can be drawn from a midline....as long as it draws back.  It is not a reliable method of obtaining labs because it is problematic after a few days (variable from patient to patient) to get a blood return and yet the midline is functional regarding infusions. 

So it's likely a patient may get peripheral sticks anyway.

Thank You

I would appreciate any clinical study result on midline effectiveness. We have found midlines to last for 3 to 4 days. At this point we can no longer achieve blood return. With no blood return we discontinue the line. So, why not place a regular peripheral IV instead? We never had the volume of patients to do an effective clinical study. We stopped placing them after we discovered they were not meeting the need. I have been hoping that a larger hospital would do a study on this.

I am aware of what the INS standards say.  All I can say is that my experience over 3 decades with midlines has been that this is a consistent characteristic regardless of dwell time.  However, we are placing less midlines in general in favor of PICCs.  They still have their place though.

In regards to "always a blood return", my thinking is that this is impractical for PIVs.  I have placed PIVs (in peds) and after securing may not get a blood return, yet I am confident it is where it should be.  An astute observer will consider multiple factors in addition to the presense of a venous return and not consider that alone (central catheters are a different story and should always be investigated).

It is not feasible and does the patient a great disservice to replace an IV every few hours because there is not a blood return when every indication is that the PIV is optimally functional.

Absolutely agree...blood return is only one component of many involved in assessment.  But putting a higher emphasis on blood return  in PIVs will not necessarily result in better assessments or less wrong statements by the bedside nurse if that is their only focus. And for PIVs, I would prefer that they assess for all other factors you mentioned first...because it is possible to have a blood return in a grossly bad IV.....    In fact, it's not at all unusual in our patients who, unfortunately, recieve peripheral TPN ( a practice I know is not done in adults).  Sometimes because of that blood return, the nurse elects to leave an IV in that is painful, red, edematous and destroying the vein.  So I guess I'm a bit sensitive about the statement "But it still has a blood return"

I certainly agree education is vital and I truly believe that all of us on IV-THERAPY.net educate and educate to the best of our abilities.  Nevertheless, I know I am not alone in being frustrated in seeing poor assessments and decisions made in the basic aspects of IV therapy on a daily basis... despite education.  All nurses can't be experts in all matters but I'm referring to basic concepts and thought processes, not complex theories.

Sorry to digress  from the midline topic