Forum topic

3 posts / 0 new
Last post

When inserting Midlines, should you cut the catheter to reside at the level

of the auxilla, or just keep it at 20cm no matter how far up the arm it is


Robbin George
I have been thinking about

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

Midline tip location

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, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

Log in or register to post comments