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Michael Drafz
Gentamycin via Midline?

We are fighting a battle with one our MD's who is insisting on infusing Gentamycin via Midline. Our team has taking a stand on infusing via PICC, based on pH. Pharmacy is not backing us up. What is everyone else out there doing (if you are still using Midlines)?

I am ready to pull the plug on Midlines, since MD's seem to think they are the solution to prevent all the complications associated with PICCs and they are really only for a very small number of people.

Thanks for your input in advance!

Michael Drafz RN, CRNI

Vascular Access Specialist

Sharp Memorial Hospital San Diego, CA

mary ann ferrannini
Michael, What ph is the

Michael, What ph is the Gentamycin you are using as this can vary slightly. I have to say that we rarely place midlines anymore. The last several I have placed have been on patients needing PCA,that were going to home to die within a few days. Sometimes I do get a special request for one by an MD for a patient that is self pay. This has been this way for at least the last 8-9 years and especially since they took the Landmark midline catheter off the market. One of our big problems was getting our nurses to comply with the restrictions that we placed on them,not to mention proper assessment skills. We would place a midline,and leave an information sheet on the rand clearly listing all the drugs not to infuse through this line.....then the next day or two as new MD orders came in they would useit for anything. (any port in a storm syndrome...that is a silly thing I say when nurses do not carefully assess what they are administering and then administering it in the safest access available at the time or at least securing it). They would often mistake it for a PICC as well.

Our other problem was that as patient conditions changed we found more often than not,it no longer met the patients needs anymore and we would have to place the PICC anyway. Those were just some of our issues! The midline has it own set of complications. I have seen some of the worst phlebitic veins from the use of these lines . On rare occasions we will pull a malpositioned PICC that has not made it past the axxilary vein and this is only if the therapy is within the acceptable ph and osmolarity range and we are out of other options. As you can tell we are not fans of the midline.

Our MDs rarely request them anymore and if they do we usually call them and get the scoop. We still maintain a policy though foe when we do place them or for when we admit a patient with an existing midline.

By the way the evidence and recommendations for the ph and osmolarity restrictions placed on these lines is out there. So I would present that to pharmacy

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