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Midline insertion

We have a request from a facility to insert midline catheter in the upper arm for short term use (5-7 days). They are specific about the insertion site. Also do not want X-ray.  Catheter tip will be distal to the axillary vein.

Do any one use Ultrasound and insert midlines in the upper arm? If yes, which product you use?


Many companies make

Many companies make midlines, we happen to use Bard.  They are not a full kit so you have to accumulate the guidewires, flushes, stat lokcs, etc.  You can use a full PICC kit and cut it down to midline length, but that is off label use and many practitioners frown on that.  We do that fairly often but we place a tag on the catheter itself labeling it as  a midline, as well as a sign in the room indicating  it's a midline.  As far as x-ray, it's good that they don't want one, because all it's going to show is the catheter is "seen in soft tissue"  because the x-ray can't see blood vessels.

Carole Fuseck
Our facility uses U/S

Our facility uses U/S guidance, basilic vein placement above the antecubital, and sterile technique just as if we were inserting a PICC.  We also do not obtain an x-ray.   The same company that supplies your PICCs can most likely provide the midlines.  We happen to use a single lumen 4 FR. 

I must add that if you are going to insert midlines in a patient population where nursing staff is used to seeing PICCs, education and competency is going to be extremely important because the two lines are very similar in appearance externally.  The staff working with the line needs to be aware of the very significant differences.  We post a sign over the bed that indicates that the patient has a "MIDLINE" to right or left basilic to call attention to this, in addition to the usual documentation.


Very important comments from

Very important comments from Carole. A midline is not interchangeable with a PICC but similarities can lead to bad judgments about infusates from some nurses.  


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

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

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

Carole, we had the same

Carole, we had the same issue as you did with staff not being able to distinguish between a PICC line and Midline. We never place Midlines intentionally, just sometimes end up cutting a intended PICC short if we cannot float it to the central circulation.

We always post a Picc information form on the headwall of the patient room and have different colored sheets for Midlines. However, more often than not, this form does not move with the patient when the patient moves to a different room in the institution.  We have now started to print little stickers in the same color (bright red) as the Midline sheet and place them on each port of the Midline. 

They read:  Midline


                 No Ct scans  

                 No Vesicants

This seems to work much better,



Carole Fuseck
I recently posted this

I recently posted this attachment at one of our sites to remind the nurses of the differences.  It is basic but helpful to them.  Just an idea you may want to consider.



Chris Cavanaugh
This is a very good document
This is a very good document for education of staff nurses.  However, I am concerned regarding your statement that the Midline lies in the axillary vein.  It should end in the cephalic or bascilic vein, before it enters the axillary, terminating in the shoulder area of the patient, never entering the chest.   You may want to look at that.

Chris Cavanaugh, RN, BSN, CRNI, VA-BC

Carole Fuseck
Thank you for noticing my

Thank you for noticing my error in wording.  I am changing my document ro reflect INS standard 42.3 as you stated.

I am attaching the new one for anyone who may want to use it.


Carole Fuseck
Excellent practice for

Excellent practice for patient safety!  We have quite a few different labels in use already, I am going to suggest that at our next meeting.  I'm sure this also falls under the "tubing labels for all high-risk lines" requirement from Joint Commission.  


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