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Midline dwell time INS 2021


So Midlines(VAD's) can stay in as long as they do not have complications? so months? I have not caught up with all the new INS standards.  So midlines do not follow the 28 day limit? Also, anyone know if they plan on implementing declots for midlines? A large amount of drug therapy requiring longer than a month need on going lab work and a large amount of midlines (all types) stop returning blood at some point and a handful work for the duration. It is hard to say let's place a midline knowing the therapy is for several weeks or longer with the lab draw being a concern.  Anyone else not sure about using midlines for longer term drug therapy?  Or please correct me with INS standards. I have had too many life events to keep up at the moment.  Thanks,  Denise 


29 or 30 days is NOT a

29 or 30 days is NOT a recommedation for the maximum dwell time. It is not based on ANY clinical data whatsoever. It represents a category of VADs defined by t he FDA as intended for less than 30 days. This decision is made by engineers on their intial application to the FDA; it is not used by all VADs in this category; and the language varies greatly between the manufacturers that do use it. There are 2 acceptable times to remove any VAD including midlines - one is when it is no longer needed to deliver therapy due to the end of therapy and two is when there is an unresolved complication. There is no length of dwell assign to any VAD, peripheral or central.

Decloting midlines with a thrombolytic agent  would depend upon the labeled indications approved by the FDA for the drug manufacturer. I am not aware of any manufacturer of any thrombolytic drug doing the extensive research required to get the FDA to change their labeling. It is being used on an off label basis and there is at least one study on thrombolytic agents in midlines. 

The 2021 INS SOP on VAD Planning contains a lot of new information on what to assess and what is and is not appropriate for choosing a midline. Please read that SOP for details. Just remember a midline is in a peripheral vein and the vein diameter and blood flow is no where near that of the SVC and a CVAD tip location. Multiple drugs, irritants, vesicants, etc are not appropriate for using a midline. Therapies up to about 14 days is what is recoommended for a midline. 

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

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

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