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Midline questions

We recently had a patient who required long term (~ 6 weeks) of IV abx. Hx of IVDU and a known hard stick. An attempt was made to place a PICC in the radiology suite under flouro, but they were unable to advance the catheter over the guidewire. Upon US both extremities, it was noted that there were B/L basilic thrombus. The radiologist terminated the procedure and declined to place another line. Fast forward 5 1/2 weeks and we have thus far placed 6 or 7 midlines for a variety of complications (leaking, patient pulled out, red, etc.). On to the questions:

1. Does anyone have a suggestion as to what may have worked for this patient since a PICC was out and midlines failed so frequently?

2. With the thrombus's B/L, what is the recomendation for placing a midline in these veins? My assumption is that is why the lines placed in these veins failed. 





A tunneled PICC via the IJ is

A tunneled PICC via the IJ is commonly placed by IR in similar situations.

A low IJ insertion of a CICC

A low IJ insertion of a CICC would be indicated in this situation. Also use of long PIVCs in the forearm would be another option. Failure seen with leakage, lack of a blood return, pain, etc is related to the presence of thrombus and those veins are not appropriate for insertion of any VAD. Obviously the patient pulling out the catheter was not related to thrombus. 

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

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

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