Hi Everyone,
Does anyone else have issues with clear fluid leaking from the midline insertion sites? This problem has become more frequent and results in having to insert a new midline catheter. The leaking has occured with midlines in place for only 2 days to those midlines in place a week or longer. Sometimes it is clear, watery body fluid or it is the flush solution or the infusing medications. I am collecting data such as vein, location on arm (near ac or higher), trimmed catheter length, inserter technique, blood return present or not, etc. The most common theme is that the midline does not have a brisk blood return or blood return is absent. This has become such a frequent problem that I feel the midlines are creating more work, increasing costs, and are a riskier vascular access device than the 2 inch PIV we insert or the PICC lines. Any suggestions would be helpful.
This is a common sign of vein occlusion such as a thrombosis forming. Infused or injected fluid will not pass this obstsruction, causing retrograde flow and leakage from insertion site. You did not include one of the most important factors to assess before insertion - catheter to vein ratio. New evidence reveals that the catheter in any peripheral vein should consume no more than 1/3 of the vein lumen. Catheters too large cause mechanical irritation to vein wall, which is the beginning of thrombosis. The next thing to assess is correct tip location. It must be level with the axilla or armpit and never into the shoulder where joint motion causes more mechanical irritation to vein wall. These factors begin vein occlusion which prevents adequate blood flow around the catheter. This limits the blood flow that provides additional dilution for the medication. For a PICC, catheter to vein ratio is important to reduce risk of mechanical irritation. Chemical irritation is not an issue with with PICCs like it is with midlines. Trimmed catheter length alone may not tell you that the tip is not in the shoulder. Select your insertion site, then identify the spot on the arm that is level with the armpit, measure between these 2 sites and insert only that length of catheter. Have you assessed any of these leaking tip locations with US?
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
i have found with the new midline that unless they are dressed upward they have a tendency to piston when the arm bends there fore causing leakage. If I turn the midline it has solved the problem
Catherine Amero, MSN/ED, CRNI
Milford Regional Medical Center
Clinical Educator- Infusion
Non-compressible vein segments are a consistent finding along with a lack of blood return when I have assessed leaking peripheral VADs with US. As Lynn pointed out, with a PICC there aren't concerns with chemical phlebitis that exist with a midline. I am surprised there is not more public concern for midline related thrombosis. I am aware of little discussion in literature that relates lack of blood return to US assessment and findings of thrombosis.
Nancy Rose
Actually, there is a great deal of discussion in medical literature on blood return from CVADs. See INS SOP on VAD Malposition. But there is very limited discussion of blood return from any peripheral catheter, yet it is a vital part of the patency assessment for ALL VADs, peripheral and central.
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