Forum topic

Hi. Just adding an additional question to this list...The INS competency for placing a midline identifies obtaining a consent.

Does anyone not do this? The idea is that this is a longer dwell PIV. I think that a consent is needed as it is placed with the same setup as a PICC and we can use the same veins as a PICC placment.

Just wanted to get some feedback on this.

as for the original questions:

I a) yes

b)yes

c) No

d) No

 IIa) no to all

IIIa) Saline all populations

IV Not at this time but may happen at some point

V. Not typically, but with extenuating circumstances, we may after discussing this with the physicians or APN

VI.it is hard to track. if a patiet leave our institution  we do not know. We place less that 50 midlines a year from a recent data collection that I did

VII- Yes. Our outpatient clinic will place a midline if therapy is less than 4 weeks and the pH ans Osmolarity are appropriate

I've recently been to the website called "PICC Excellence, Inc." The creator of the website offers many excellent educational videos. I've learned so much from her website, and I believe she is currently offering a free CEU specifically for Midlines. If you have the chance, you might want to check it out. She incorporates INS standards and evidence-based practices into her educational offerings. Also, the manufacturer of your Midline catheter usually offers education regarding their product. We use the Arrow product and consider ourselves fortunate to have a really experienced and expert nurse educator available to us.

Yes, we place midlines.

Trim?  NO

Xray?  NO

VPG?  NO

Arm circ?  Yes, for all.  On insert and with dressing change.  10 cm above insertion site or half way between insertion site and axilla

Flush?  NS

Auditor?  NO, is a peripheral line

Febrile patients?  Yes

Leave in:  30 days or longer if still needed and no complications

Discharge with midline?  Yes

I. Yes
a. Yes
b. No
c. No
II. Yes
a. All - we only do adult
b. Insert and dressing change
c. All
d. Our policy states 12cm above the AC. So no marking, just measure 12cm above AC and measure circ.
III. Flush with Saline
IV. We always had a 2nd person present
V. Yes
VI. 2-4 weeks
VII. Depends if pt is going somewhere that will accept a midline.

Our new process does not require a cut down, but other items remain the same.

Yes we place midlines using ultrasound.  Midlines are long PIV's, not central, midclavicular, or subclavian lines.

If you are cutting PICCs you are using the product off lable.   So the answer is no.

ML's are placed below the shoulder if over the shoulder we call it a midclavicular line, and infuse as if a Midline, not a central line.  We do not Xray.

I am not sure what VPG are?

We do not measure arm circumference, but not a bad idea.

We only flush with Saline all polplations

Again we are placing a long PIV we use aseptic technique with some exceptions sterile gloves, long arm prep, weekly dressing changes, cap changes 2X a week.  Instruct nurses to aspirate prior to  administering Medications.

Our Midlines can stay in 29 days, they average 18- 21 days

We have discharged hospice and ABX patients with HH follow up

I. Yes, we place Groshong midlines, have PowerGlides available, and are trialing PowerWands.

   a. Groshongs are designed to be externally trimmed to fit; no trimming for others

   b. No xrays

   c. No VBGs unless US view was unclear or there is some indication that placement may be arterial

II. Yes, arm circ above where tip lies according to length of line

   a. Yes, for all

   b. We measure on insertion and removal, and during dwell if suspicion of complication arises (discomfort, occlusion, swelling, induration, etc)

   c. For all situations

   d. Our PGs and PWs are 10cm, so nurses are instructed to measure above 10cm from entry; Groshongs are custom length, but we routinely site the tip 2cm below axilla, so circ is measured with measuring tape in the axilla and around the arm

III. Saline for all (adult population), but we would consider heparin if patient had recurrent occlusions that were clearly intraluminal clots and not a mechanical problem

IV. We use full barriers and assistant for Groshong, but no separate consent or insertion checklist. For PG and PW, hat-mask-sterile gloves-partial drapes, and assistant if available

V. Yes if venous access is poor and there is a need for peripherally appropriate meds/fluids

VI. We treat like a short peripheral catheter and remove when clinically indicated

VII. Yes, most f/u with our hospital's internal outpatient center or external infusion clinic, some with local VNA or SNF.