Does anyone know of any studies that relates higher DVT/thrombus rates to midlines? If they do were they trimming a picc to midline lenghth or using an approved midline catheter. I know many piccs have a reverse taper so that the larger portion of the picc is in the smallest area of the vein. The powerwand has no reverse taper and will be out in a 4f soon. If anyone has any information or expierence with the powerwand or Bards' midline kit please post.
Thank you,
Frank
Higher rates as compared to what? I have never seen a study comparing outcomes for midline catheters compared to any other type of catheter - PIV or CVAD.
No real published evidence for or against a reverse taper either. 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
Sorry for the confusion Lynn. I meant to compare them to PICC's. As for the reverse taper I have never read any studies either I was just curious. It would seem to me that if you have a reverse taper of 6-7f in the vein it may contribute. I don't know of anyone that has actually looked into reverse tapers but I think it would be an interesting subject. Since some tapers start at the 7cm, some at the 3cm, and yet some have no taper, you could have as much as 5 cm of the taper in the smallest part of the vein. I have read a couple of studies that relates size of catheter to thrombus.
Thanks for you time. I really appreciate your advice.
Frank
Frank,
We place approx 60-80 Bard Midline Groshong catheters monthly, and it is rare that we see complications using this catheter. Most of these lines are placed for time frames of 10 days to 4 weeks.
However, if the pt has a medication outside the INS standards for peripheral placement, they will usually get a PICC.
Frank,
We place approx 100-125 Bard and Vygon 3Fr and Bard 4Fr Midlines each month, it is very rare to have any complications. The most common is a phlebitis. Our lines are in for 1 week to 1 month depending on therapy. We never ever trim PICC lines for use as a midline.
At our hospital, we use the Bard 4 fr Midline kits. At times we trim the midline catheter to accomodate the length from the insertion site to the end point below the axilla.
It is a matter of safety that we use a manufactured Midline kit. The word "MIDLINE" is manufacture stamped on the line. That way there is no confusion whether or not it is a PICC or Midline.
It was decided unanimously by the safety committee that it is unsafe to cut a PICC manufacture stamped PICC to the length of a midline.
Lois Rajcan, MSN, RN, CRNI
IV/PICC Team Leader
The Chester County Hospital, West Chester PA
This is totally anecdotal. I wish we had actual numbers.....but something to consider anyway.
Midlines fell out of favor several years ago for our team because we felt like they didn't last & frequently developed DVT. We stopped stocking them all together, it was so bad. Then at some point we began trimming the PICC's for midline length. I joined the team about 3 yrs ago and started poking around looking for info to improve our practice. We have slowly made some changes and have recently seen midlines that lasted months. Here's what we changed:
1. Measure to the axilla. I know this seems "duh" but our team was just trimming @ 20cm and inserting the whole line. Based on the insertion site on the upper arm, some of those had to have been midclavicular lines. No wonder the DVT rate was so awful.
2. Don't trim the line. We stock a 20cm midline (BARD 4FR and 5FR). The access point must be above the AC but low enough to allow at least 15cm of the catheter in the vein. We allow up to 5cm "on the skin". Our preference is only 1-2 cm on the skin but allow up to 5. If you were trying to place a PICC and could not get it to advace past the shoulder for whatever reason, the access point must be low enough on the arm to allow 15cm of the catheter to be in the vein but not extend past the axilla. This may mean starting over with a new access site. We used to trim the Power PICC but that was obviously bad practice because a month from now after the pt has been in rehab & a nursing home & had many dressing changes, there is no way to identify that it is a midline. It still looks like a Power PICC from the outside. We labeled the dressing and charted the heck out of it, but who knows what others do down the line. Too risky.
3. Avoid the Cephalic vein for midlines. I read a study (it is buried in my papers) that compared DVT rates based on tip location and the Cephalic vein was strikingly more risky.
4. Insertion & maintenance are done exactly like a PICC line. The infections are not tracked with the CLABSI rate but we still want a zero rate on any patient we poke.
Again, this is purely anecdotal. We have no way of tracking all patients. We are a regional hospital that serves patients from as far as 300mi away. We place the line and they go home to recieve services from their local small town hospital. All we know is the feedback we are getting from the Dr's that manage the infusions. They are now seeing midlines that hold up for 6-8 weeks.......a BIG suprise to us.
HTH
Martha
This is totally anecdotal. I wish we had actual numbers.....but something to consider anyway.
Midlines fell out of favor several years ago for our team because we felt like they didn't last & frequently developed DVT. We stopped stocking them all together, it was so bad. Then at some point we began trimming the PICC's for midline length. I joined the team about 3 yrs ago and started poking around looking for info to improve our practice. We have slowly made some changes and have recently seen midlines that lasted months. Here's what we changed:
1. Measure to the axilla. I know this seems "duh" but our team was just trimming @ 20cm and inserting the whole line. Based on the insertion site on the upper arm, some of those had to have been midclavicular lines. No wonder the DVT rate was so awful.
2. Don't trim the line. We stock a 20cm midline (BARD 4FR and 5FR). The access point must be above the AC but low enough to allow at least 15cm of the catheter in the vein. We allow up to 5cm "on the skin". Our preference is only 1-2 cm on the skin but allow up to 5. If you were trying to place a PICC and could not get it to advace past the shoulder for whatever reason, the access point must be low enough on the arm to allow 15cm of the catheter to be in the vein but not extend past the axilla. This may mean starting over with a new access site. We used to trim the Power PICC but that was obviously bad practice because a month from now after the pt has been in rehab & a nursing home & had many dressing changes, there is no way to identify that it is a midline. It still looks like a Power PICC from the outside. We labeled the dressing and charted the heck out of it, but who knows what others do down the line. Too risky.
3. Avoid the Cephalic vein for midlines. I read a study (it is buried in my papers) that compared DVT rates based on tip location and the Cephalic vein was strikingly more risky.
4. Insertion & maintenance are done exactly like a PICC line. The infections are not tracked with the CLABSI rate but we still want a zero rate on any patient we poke.
Again, this is purely anecdotal. We have no way of tracking all patients. We are a regional hospital that serves patients from as far as 300mi away. We place the line and they go home to recieve services from their local small town hospital. All we know is the feedback we are getting from the Dr's that manage the infusions. They are now seeing midlines that hold up for 6-8 weeks.......a BIG suprise to us.
HTH
Martha