Does anyone have their floor staff nurses inserting midline catheters or do you use an IV team?
I have never seen primary care staff nurses inserting midlines and do not bellieve this should be part of their scope of practice. They do not have the time to do the complete procedure as it should be done due to a full patient load. Think about the current skill level with short peripheral catheters, how the procedure may be cut short in the interest of time or the lack of skill. This should remain in the hands of specialty infusion/vascular access nurses. 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
Just to clarify, is the concern with bedside Nursing placing midlines a concern that they should not have a patient load while placing lines, or that midlines should only be placed by a dedicated PICC/IV Nurse? In my neck of the woods many of the facilities don't have the volume to support full time dedicated vascular access Nurses, although they still have Nurses who become competent in PICC/midline placement but they do other things as well, if they aren't placing PICCs or midlines then that would mean many more Central lines, which I had thought should be avoided when PICCs or midlines could be used instead.
Both things are problems. First, the large category of central vascular access devices includes PICCs. A PICC is a CVAD. Placing a PICC instead of a CVAD brings some advanteges like eliminating pneumothorax, pinch-off syndrome, but the rate of BSi with a PICC is about the same other all percutaneous CVADs.
PICC and midline insertion requires the advanced knowledge and skill of a specialist in infusion and/or vascular access. This is not a practice that should be put in the hands of generalist nurses. They do not have the same level of expertise as a specialist nurse.
I have seen situations where ICU nurses were assigned to put in all PICCs. No one was left to take care of their patients while they were putting in PICCs. These nurses had to refuse to put in PICCs because of the risk it was causing to their ICU patients. No primary care nurse can manage a load of patients and put in PICCs or midlines. It is not safe or appropriate to expect them to do this.
I was referring more midlines, which I believe do have a much lower rate of infection. Currently, many small facilities place midlines with staff who perform other duties as well, although typically not at the same time as they are placing lines, saying that is no longer appropriate would meaning many lines that otherwise would have been placed as midlines would now be placed as central lines, which would likely increase infections, I guess what I'm asking is if that's really worth it.