When a new Midline is placed does IV admin set (say from a CVC) need to be changed?
IF a MIDLINE is in place, can another PIV be placed on same extremity?
Does anyone know flow rate of Midline placed just below axilla? If duel lumen, can incompatible medications be administered at the same time or is this contraindicated?
Thanks
Mary G
Mary,
To your first question; do you mean replacing a set conected to a CVC prior to inserting a new midline? If this is the case, I don't see a strong clinical need for doing so if the set has been properly taken care of.
The INS Standards in its latest edition recommends not changing Continuous Infusions sets more often than 96 hours; sticking to that 4 days cycle seems the best way to go!. It also instructs to change the set any time there's a new CVAD inserted or PIV replaced (this seems pretty obvious, but it isn't unheard cases in where sets are not replaced after replacing the VAD itself!!).
Francisco Cuesta
(858)263-9024
But, doesn't INS also state that upon site rotation that tubing/admin set needs changed?
Erin Spires, RN
Yes, indeed, the INS standards calls for every set to be changed when a new VAD of any kind is inserted. This applies to PIV, midline, CVADs, all of them. Any set that has been attached to a hub of any kind is considered contaminated and would need to be changed. Lynn
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
If there are no other options for placing PIV, you could use the forearm for insertion of a PIV with a midline in the upper arm. I would hasten to ask why you would want to do that though. If there are multiple therapies, a dual lumen PICC may be more appropriate and this needs to be part of your initial assessment for the most appropriate VAD before inserting anything. Dual lumen midlines have very little, if any, evidence to identify their outcomes. Basilic vein at the level of the axilla is the preferred vein and tip location as it is the largest diameter of the arm veins but it is half or less of the blood flow in the SVC. A midline can NEVER take the place of a CVAD. Flow rates of the catheters are found in the product instructions for use and are performed in a lab by international standards. Blood flow in the veins of the upper arm has many variables such as vein diameter, hydration status, blood pressure, etc. Lynn
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
it does :)
Francisco Cuesta
(858)263-9024