It was a Facebook page for PICC/IV nurses. Now that I am at my desk, I have copied and pasted it here:
I strongly believe that midlines are a viable part of vascular access. However there are issues with their use and the new types are causing lots of confusion. Disclaimer- I am biased because I was part of the team that introduced this concept and the first midline device to the market. Midline is defined by tip location and NOT by device length. This means the new devices are NOT acceptable for placement anywhere on the upper extremity. There is no optimal dwell time even though recent marketing would lead one to believe that they should dwell for 29 days. This time frame applies ONLY to how the device received its FDA clearance as a "less that 30 days" device. This is not based on outcome data and does NOT indicate the maximum or optimal dwell time. Extreme care is required when assessing patient needs. A midline can never be expected to replace a CVAD. If pH, osmolarity, vesicant nature, etc. require a CVAD, then a midline is NOT an acceptable alternative. Midlines are a replacement for multiple peripheral sites. This means a high level of knowledge and skill to correctly choose a midline. External appearance can be confused with a PICC and this could lead to horrible outcomes if therapy changes to one that would require a CVAD. Yes, they have a place and can provide patient benefits, but just like all VADs, they require knowledge and critical thinking for a positive outcome.Lynn
I am seeing a lot of midline picc's coming into my infusion center and they are all placed in the upper arm, basilica. They terminate before the axilla.
We are considering the BARD PowerGlide midline catheter as an alternative to PICCs or regular IVs for a specific subset of patients (no irritating medications, pressors, etc. and need more than 3-4 days of IV therapy). What experience do people have with this catheter?
All midlines should only be considered as an alternative to short peirpheral catheters. It should never be considered as an alternative to a PICC or any type of CVAD. It sounds like you are referring to those PICCs placed when a central tip location is not truly needed. Lynn
I am also getting a lot of these catheters in our infusion center. The insertion is in the upper arm vein and terminate before the axilla. To clarify what I said below. They look like a picc line when they come in. They are dressed the same way also.
Yes, that has always been an issue with midlines. The word "midline" or "PICC" is printed on the hub of many brands. That helps if nurses do actually read them. Lynn
Mark, in my experience here, I would answer with a resounding no. When I work bedside, the information passed in report is "he has a picc". Upon assessment I find a midline, often times with vancomycin ordered. Nurses are well able to distinguish devices IF they are taught. The barrier in my work place is administration, I'm accepting all tips and advice to overcome this barrier.
From my experiences, in non acute care points of care,
rarely does the patient / record have the insertion information. No description of the product, length of inserted line, external line or tip location, # of lumens, vessel location, power or not; any complications on insertion.... type of care needed - valved or not, type of caps -I do not think I ever met a SNF nurse who had any idea caps had differences. (negative, positive, neutral)
Many times staff are not familiar with the differences of any of the products and receive minimal training... or forgot the training because they do not regularly deal with
infusion therapy.
The places that have pharmacy support forget they have a policy book for IV care and many times the policy book has not kept up with advances in practice / new product updates.
I urge all - send the data with the patient !! educate the patients and the staff who will be caring for the line. Label the site.... NOT a PICC/ or MIDLINE... anything....
A
Marty, I just wrote a lengthy reply on the other site where you posted this question. Please check there. Thanks, 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
Hi Lynn,
What site did you reply to Marty on re. Midlines? I am interested in what you had to say.
Ellen Snell, BSN, RN, VA-BC
Children's Mercy Hospital and Clinics
Vascular Access Team
Kansas City, MO
RN, BSN, VA-BC
Children's Mercy Hopital
KC, MO
It was a Facebook page for PICC/IV nurses. Now that I am at my desk, I have copied and pasted it here:
I strongly believe that midlines are a viable part of vascular access. However there are issues with their use and the new types are causing lots of confusion. Disclaimer- I am biased because I was part of the team that introduced this concept and the first midline device to the market. Midline is defined by tip location and NOT by device length. This means the new devices are NOT acceptable for placement anywhere on the upper extremity. There is no optimal dwell time even though recent marketing would lead one to believe that they should dwell for 29 days. This time frame applies ONLY to how the device received its FDA clearance as a "less that 30 days" device. This is not based on outcome data and does NOT indicate the maximum or optimal dwell time. Extreme care is required when assessing patient needs. A midline can never be expected to replace a CVAD. If pH, osmolarity, vesicant nature, etc. require a CVAD, then a midline is NOT an acceptable alternative. Midlines are a replacement for multiple peripheral sites. This means a high level of knowledge and skill to correctly choose a midline. External appearance can be confused with a PICC and this could lead to horrible outcomes if therapy changes to one that would require a CVAD. Yes, they have a place and can provide patient benefits, but just like all VADs, they require knowledge and critical thinking for a positive outcome.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
Lynn, Thank you very much!
Ellen Snell, BSN, RN, VA-BC
Children's Mercy Hospital & Clinics
Vascular Access Team
Kansas City, MO
RN, BSN, VA-BC
Children's Mercy Hopital
KC, MO
I am seeing a lot of midline picc's coming into my infusion center and they are all placed in the upper arm, basilica. They terminate before the axilla.
I am not sure what you mean by a "midline PICC ". These are 2 different tip locations. 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
We are considering the BARD PowerGlide midline catheter as an alternative to PICCs or regular IVs for a specific subset of patients (no irritating medications, pressors, etc. and need more than 3-4 days of IV therapy). What experience do people have with this catheter?
John Hallowell, PA-C, MBA
Director of Physician Assistant Services
Southside Hospital
301 East Main St.
Bay Shore, N.Y. 11706
All midlines should only be considered as an alternative to short peirpheral catheters. It should never be considered as an alternative to a PICC or any type of CVAD. It sounds like you are referring to those PICCs placed when a central tip location is not truly 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
I am also getting a lot of these catheters in our infusion center. The insertion is in the upper arm vein and terminate before the axilla. To clarify what I said below. They look like a picc line when they come in. They are dressed the same way also.
Yes, that has always been an issue with midlines. The word "midline" or "PICC" is printed on the hub of many brands. That helps if nurses do actually read them. 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
I want to re-write and re-ask your initial question: Does the average nurse know the difference between a PICC and a Midline????
This is the education focus we as Vascular Access Specialist and Infusion Specialist need to addressed... in my view.
Mark, in my experience here, I would answer with a resounding no. When I work bedside, the information passed in report is "he has a picc". Upon assessment I find a midline, often times with vancomycin ordered. Nurses are well able to distinguish devices IF they are taught. The barrier in my work place is administration, I'm accepting all tips and advice to overcome this barrier.
From my experiences, in non acute care points of care,
rarely does the patient / record have the insertion information. No description of the product, length of inserted line, external line or tip location, # of lumens, vessel location, power or not; any complications on insertion.... type of care needed - valved or not, type of caps -I do not think I ever met a SNF nurse who had any idea caps had differences. (negative, positive, neutral)
Many times staff are not familiar with the differences of any of the products and receive minimal training... or forgot the training because they do not regularly deal with
infusion therapy.
The places that have pharmacy support forget they have a policy book for IV care and many times the policy book has not kept up with advances in practice / new product updates.
I urge all - send the data with the patient !! educate the patients and the staff who will be caring for the line. Label the site.... NOT a PICC/ or MIDLINE... anything....
A
Ann Zonderman, BSN, JD, CRNI
New tag/label for midlines/long dwell pivs...
information flyer: http://ivtags.com/docs/brochure-midline.pdf
this is a new tag/label offered via www.IVtags.com
Label midlines/long dwell PIVs with important restrictions for use and insertion date.
Snaps on and off for easy removal during tubing changes.
Comes with prep-resistant ultrafine marker.
Kevin Arnold RN, MSN