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stemc
Midline questions

We have a few questions regarding midlines.  We are planning to use them only as a last resort unable to place any other access.  First does anyone get a consent to place them? Our manager would like us to still get a consent.  Second do you measure daily arm circumference or just initially and then if there is a problem.  Thank you.

lynncrni
I personally think that

I personally think that midlines have much greater use than as a last resort. They are considered a peripheral catheter and I have never worked where a consent for insertion was required. Daily midarm circumference is not recommended as there is no evidence to support this practice. Get a baseline and then repeat if there are any signs and symptoms of complications. Also carefully choose the patients you will place these in. A midline is a substitute for repeated peripheral venipunctures but if there are indications for a central line (pH, osmolarity, vesicants, etc) a midline will not solve your problems. In fact using a midline when a CVC is indicated will increase your problems. When properly chosen, a midline will work well but it requires a careful assessment of all factors. 

 

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

www.hadawayassociates.com

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

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

Jule G
We have recently had a home

We have recently had a home infusion patient with a midline placed in the lower part of the arm receiving 2 gm Rocephin BID.  Insertion site is 4 inches above the WRIST.  Developed redness and tenderness below the antecubital area (assumed catheter tip location) after two doses.  Spoke to director of outpatient facility that placed the midline and questioned choice of insertion site and was told that that is "okay"...doesn't the site they chose for insertion defeat the purpose of placing a midline in the first place??  How do I educate this facility on the appropriate placement of midlines?  We don't want our homecare patients having midlines in their lower arms!!!!

 

lynncrni
This is not a midline

This is not a midline catheter, regardless of what was marked on the external catheter. They may have used a midline catheter incorrectly but the catheter tip for a midline is located in the upper arm, distal to the shoulder, level with the armpit in either the baslilc or cephalic vein. Regardless of what any physician said, this would be managed as any other short peripheral catheter and would never fall under the recommendations for a midline catheter. 

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

www.hadawayassociates.com

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

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

jordanhosp.IVT
I agree that was poor
I agree that was poor placement of the midline..it if however a good idea to measure daily the arm circumfrence.I also believe a PICC should have been ordered for home therapy.The midline is a poor choice for home IV access..they are usually a 3Fr. and do occlude easily..arm circumfrence is measured and recorded as these line are prone to developing phlebitis.
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