we have been inserting a lot more mid lines at our hospital, the questions that always come up are, 1. can we draw blood from a midline. 2. Can Alteplase be used on a midline that is clotted or is having no blood return. I believe that using Alteplase on a midline is considered off label use, because it has not been tested on midlines. That being said, are there any facilities out there that are drawing labs from a ML, and/or using Alteplase to declot.
Thank you
Sharon Irvin, RN,BSN
Sharon if your policy allows for blood draws through midlines and the the line has a good blood return - go for it! Usually a smaller syringe will work better for blood draws and take care not to place the tourniquet at the catheter tip. (Most times a tourniquet isn't even needed.) Pull back slowly. Alteplase is up for discussion, Mickey Hawes is doing research right now and we should have results from her work in the near future. The big question is why doesn't the line draw? Is it a clot or inflammation in the vessel? And would it be helpful to instill Alteplase at the tip where the vein is already compromised? Some use Cathflo on midlines, some won't. Some types of lines claim to draw longer and better than others. We don't have all the answers yet and perhaps each patient case is different. The answer here then is a solid "maybe". More information is on the way.
thank you, Jill
its still such a gray area, I know in the units they draw blood off PIV and mid lines. I will be looking for the research
Sharon Irvin, RN, BSN
I am not sure what your policy is for drawing blood off of peripheral IVs or midlines, however, I would not recommend placing or advertising a midline for strictly blood draws - not a whole lot of research supporting this. That being said, if a midline was already in I wouldn't be opposed to drawing blood off of the catheter (if your policy supported this). The problem that I see is inserters essentially promising their patient that this line was developed to draw labs. This is like promising your patient that the catheter is going to last until discharge. It is all about care and maintenance, what medication is going through it, proper tip positioning and insertion technique, and patient anatomy and physiology, etc. The main point though is that there is not a lot of research supporting this practice.
Due to the blood flow rates and vein size at the tip location of a midline vs. central line I would favor a central line for frequent blood draws (I'm talking labs every 8 hours or more frequent). In addition, the technique that a nurse uses to draw blood off of these peripheral IVs and midlines is a huge factor in whether or not you are going to get blood return. See Lynn Hadaway's blog and forum posts on this (smaller syringe, tourniquet, gravity, etc.). If lab is having trouble drawing blood for a once a day lab draw I will use ultrasound guidance to draw their lab sample or consider placing a central line if the patient is going to be in the hospital for awhile.
If you are asking if you need a blood return prior to the use of a midline, peripheral IV, or any VAD - absolutely!
As for Alteplase on a midline - off label use. I know there is some research looking into this, however, I would want to check for other reasons I am not getting blood return before I would ever (in the future) instill Alteplase in a midline catheter (kinks in the catheter, infiltration/extravasation, phlebitis, inappropriate tip location, etc.)
Hope this helps,
Michael Mineau RN, VA-BC, CRNI
we currently do not have a policy for drawing from mid lines or using Alteplas. Waiting for more research regarding this. Thank you for your response. It did help to clarify my Thoughts
Sharon Irvin, RN, BSN