We have recently implemented a midline practice in my hospital. Our PICC Team currently places PICCs and midline catheters and there seems to be a question that keeps resurfacing... Can we exchange a midline for a PICC or even a PICC for a midline? My initial thought is that it doesn't seem like best practice to "routinely" exchange one for the other due to a patient status change (PICC that is no longer needed for central access or a patient who now needs central access instead of their current midline).
Some of these questions also come to mind:
Should this be considered for patients who require reliable access and have no other suitable veins for PICC or midline placement? Or, should these patients instead be referred to Interventional Radiology for an alternative VAD?
Should this be accepted practice for those patients who meet certain criteria? What criteria needs to be met?
Is there any research/evidence to support the practice of catheter exchange for PICCS/midlines?
Are there any limitations for the type of midline your facility is inserting (20cm trimmable vs. 8 or 10cm as standard lengths)
Are there any facilities that are doing this? If so, what is your criteria and rationale?
Thank you in advance for your thoughts and feedback!
Historically, the most prevalent practice has been to exchange a midline for a PICC due to a change in therapy that requires a central tip location. I have been involved with other discussions highlighting the fact that many facilities are now exchanging a PICC for a midline.
First, there is very limitied evidence on ANY CVAD exchange procedures. The primary reason for exchange has been catheter damage and there are serious infection concerns with this procedure. Please see the INS Standard 51 on exchange and the associated list of about 10 publications. Also note that none of these involve exchange of a midline catheter.
Exchange of a midline for a PICC might be acceptable practice if there are no complications at or near the midline tip location. Early stages of vein thrombosis MAY cause difficulty in advancing a PICC.
Exchange of a PICC for a midline appears to be for the sole purpose of eliminating the catheter from data collection on CLABSI since midline BSIs are not reportable. To me, there is no valid clinical reason to do this exchange.
All midlines require anthopometric measurement from insertion site to tip location to determine the patient-specific length of catheter to insert. This is true regardless of which catheter design is being used.
I am not aware of any evidence to guide answers for your other questions. My company offers a midline course that is a thorough literature review on midline catheters. More information can be found at
http://www.hadawayassociates.com/midline-catheters-what-why-and-when.html
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
Thanks for your input, Lynn!
At my hospital the only time we will "exchange" a catheter is when we place a Midline and suspect the patient will ultimately need a PICC (we are waiting for - blood cultures or infectious disease input) we will place using max sterile barrier and only exchange for a PICC if the original dressing we placed has not been disturbed.
Thank you for your reply! Curious as to how your facility arrived at the decision to perform midline-to-PICC exchanges only within the first seven days (assuming that is when the first site care is due)? Is that also your policy when you exchange PICCs?