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It is off label to cut a dual lumen PICC line and make it a midline.  There is no such thing as a dual lumen midline.  I wonder why?  Could it be incompatible drugs could admix causing major issue to the patients vascular system.  I have just left an area where dual lumen PICC lines are being cut to make them midlines in the ICU.  Do not even take me there.  THIS IS OFF LABEL.  YOU HAVE ALTERED A PRODUCT FROM ITS ORIGINAL INTENTION!  The tip of a PICC is SVC.  Once again you cannot cut a dual lumen PICC and make a dual lumen midline.  Stop doing this.  It is dangerous.  There is not enough blood flow in the arm veins to prevent drug intermixing and damage to the vessels.

Kathy Kokotis RN BS MBA

Bard Access Systems

Bard Midline

Kathy, Bard makes a double lumen minline. We use it at NMH..............


dual lumen midline

I would not use it for incompatibles or vesicants.  how do you control the use of a DL midline in a ICU hospital and what goes thru it?


double lumen midlines


We've just recently started using midlines at Northwestern Memorial Hospital.  We use INS guidelines for placement.  We don't place midline catheters for ICU patients.  Most of our midline patients consist of individuals with sickle cell crisis who per history are centrally occluded and are extremely difficult to establish peripheral IV access on.  They generally are receiving IV fluids and IV analgesia.  They met midline criteria and we place double lumens for fluid infusion and blood draws.  They may be a small pt population however midlines are the right catheter choice for them.  We monitor them during their hospitalization to make sure that no vesicants or irritants are given through the midline. 

ann zonderman
Re Informed Consent... If the

Re Informed Consent...

If the process of providing the patient sufficient information  to allow patients to make an informed decision is performed and doucmented  some believe that  the signature becomes a formality but not a necessity.  Seems to be a facility decision via the legal and risk management departments. 

TJC wants to see evidence   the process was done...Legally,  clear documentation of a standard process for presenting and verifying the information  was provided to a patient would be strong evidence if there was a question to be litigated.  

  Ann Zonderman, BSN, CRNI, JD

Ann Zonderman, BSN, JD, CRNI

My understanding is that some

My understanding is that some risk managers are now considering a PICC insertion to be covered under the general consent signed on admission. As Ann mentioned, education, understanding and informed consent is still required, along with documentation of the process, even though a separate signed piece of paper is not required. 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

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