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Inappropriate midline orders

Midline ordered in ICU for nicardipine gtt.  Thoughts?

 My first thought is NOOOO!

 My first thought is NOOOO! In my facility, we have had horrid PIV cardene outcomes these past 2 months. I have to go with my gut and say don't do it. I've had to pull up Lexi-Comp for some MDs and show them where it really does say, 'Best given through a CVC. If have to be given peripherally, rotate sites Q12h.' Midlines are peripheral, so would need to be rotated 2x daily - impractical. 

That being said, every single patient situation is different and we have to examine the risks and benefits of each type of vascular access in this patient's case.  We had a very challenging patient where we actually had a multidisciplinary conference with the MDs and went through all our options, then d/w pt the risks and benefits of each, along with the contraindications to the other choices. Patient was able to make informed decision and gave informed consent. The collaborative effort really changed our practice with these particular MDs, to our benefit. They were able to hear our concerns and the gravity of the choices and the patient was very grateful in the end. U

Kathleen Crowe BSN RN CRNI

 If this drug is a vesicant,

 If this drug is a vesicant, then definitely NO? What is the final osmolarity? pH does not appear to be an issue as much as originally thought but that is still a controversial issue. Status of venous access? Length of anticipated therapy? Other infusions needed? Plus many other factors go into the process of assessing the vascular access needs of each patient. Lynn

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

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