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Mon, 03/29/2021 - 22:25

lanstan

Midline blood return

Our hospital has just advised the staff that we should be doing more Midlines insteead of PICCs. We PICC nurss do question it when we feel a midline is not appropriate and place PICCs when they are a better option. However we are doing more midlines. We do them with the bard kit with seldinger technique and usually have about 12-15 cm in place. However after about 3-4 days they often dont give a blood return. Most reesearrch says they are good for 2 weeks or more. I actually hate midlines due to thier risk of infiltrates you cant see. We havee done a picc exchange if needed. Should we do a picc exchange if no blood rreturn?

Mon, 03/29/2021 - 22:36

lynncrni

Are you measuring the

Are you measuring the distance from your chosen insertion site to the midline tip location level with the axilla and inserting that specific length of catheter? If not, how do you determine the length to insert. IMHO, most midlines end up with the tip in the shoulder area beyond the identified midline tip location. Tips in the area of joint motion is adding to vein irritation and thrombus risk.

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

Tue, 03/30/2021 - 03:36

(Reply to #2) #3

lanstan

Yes we always make sure it is

Yes we always make sure it is below the shoulder and equal to the axilla area. I know you can get pinch off also as well as thrombus risk. I am sure that would cause a loss of blood return as well. We try to use the largest available vessel as well.

Tue, 03/30/2021 - 15:10

(Reply to #3) #4

lynncrni

No, pinch off syndrome only

No, pinch off syndrome only happens when making a venipucnture into the subclavian vein. It is compression of the catheter between first rib, clavicle, and the ligaments. A midline or a PICC would not have pinch off syndrome. The catheter should fill no more than 45% of the vein lumen. How many different medications and solutions are you infusing through a midline? Please see INS SOP VAD Planning for more details about therapy characteristics for a midline.