All catheters are defined by their final tip location, not the manufactured length of the catheter. The midline tip location is in the basilic vein (preferable), cephalic or brachial veins with the tip terminating at the level of the axilla, distal to the shoulder. Please note that this is not the axillary vein as this vein begins at the lateral edge of the chest. So find your tip location, choose your insertion site, measure between those 2 points and insert the length of catheter that will reach that choosen point. At no time should a catheter intended to be a midline catheter go into the shoulder area as the joint motion could increase the risk of complications. A 20 cm catheter length with a mid-bicep insertion site could easily create a midclavicular tip location which is definitely not the same as a midline tip location and is known for causing a much greater risk of thrombosis. The midclavicular tip location is not recognized in the INS standards of practice. AVA has a position paper in opposition to its use and there has been a lawsuit involving a midclavicular catheter that resulted in a judgment for the patient of more than $7 million. This was a young man who lost his new career as a pilot due to severe thromboses that lead to complex regional pain syndrome and a lifetime of chronic pain due to the midclavicular tip location. So this tip location must be avoided. Midline tip location requires careful assessment and measurement and insertion of the specific length of catheter needed. Lynn
I have been thinking about this very subject lately as in the past few weeks I iinserted 3 midlines
I followed the exact same process we use to insert PICCs
I marked the upperarm just below the level of the axilla
Used US and MST trimming the Midline after insertion of the dilator
Each ML was a different length--One was the full 20cms one was 15cms and one was just 10cms
Each one worked out perfectly for the specific needs of the patient
Robbin George RN VA-BC
All catheters are defined by their final tip location, not the manufactured length of the catheter. The midline tip location is in the basilic vein (preferable), cephalic or brachial veins with the tip terminating at the level of the axilla, distal to the shoulder. Please note that this is not the axillary vein as this vein begins at the lateral edge of the chest. So find your tip location, choose your insertion site, measure between those 2 points and insert the length of catheter that will reach that choosen point. At no time should a catheter intended to be a midline catheter go into the shoulder area as the joint motion could increase the risk of complications. A 20 cm catheter length with a mid-bicep insertion site could easily create a midclavicular tip location which is definitely not the same as a midline tip location and is known for causing a much greater risk of thrombosis. The midclavicular tip location is not recognized in the INS standards of practice. AVA has a position paper in opposition to its use and there has been a lawsuit involving a midclavicular catheter that resulted in a judgment for the patient of more than $7 million. This was a young man who lost his new career as a pilot due to severe thromboses that lead to complex regional pain syndrome and a lifetime of chronic pain due to the midclavicular tip location. So this tip location must be avoided. Midline tip location requires careful assessment and measurement and insertion of the specific length of catheter needed. 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