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VADnurseHI
Midlines: blood draw and cathflo

Besides INS standards, are their any references regarding why midlines should not be used for routine blood draws?

Any thoughts or experiences of using cathflo in midlines?

fentanylius
If you get blood that's

If you get blood that's good, if not, not! The purpose of a Midline is not for routine blood draws. Honestly I think it makes no sense to do occlusion management, you don't do it with PIV, or? A midline is just a longer IV for me.

Andre

mary ann ferrannini
 A Midline is bit more than

 A Midline is bit more than a long IV. This line varies in length and can be as long as 20 cm with the tip residing in the upper third of the upper arm. There are some restrctions on this line because of where the tip lies. Anything with a ph of less than 5 or greater than 9 or osmolality greater than 500 should not be given through this line as the potential for damage is greater ( deeper vein, close proximity to nerves and other structures). I do know that some places do not follow these guielines but we do!!!. We discourage the use of the line for blood draws as we have noticed that it decreases it dwell time as well as nurses not flushing it properly,although on occasion we have done it in desperation. We also discourage the use of Tpa as it is not a long term line like a CVC and is usually cheaper and easier and quicker to re-site it

 

 

 

kokotis
Kathy Kokotis Bard Access

Kathy Kokotis

Bard Access Systems

It is not whether a midline can or cannot be used for blood draws in my opinion.  I think if you can get a blood draw from a midline and not stick the patient again more power to you.  The problem is around day 3-5 the midline gets what I believe is a large fibrin sheath or tail, likely an undiagnosed thrombosis non-symptomatic (I have no published evidence of this comment) and virtually stops giving you blood return anyway. 

By day 3-5 the midline is worthless in essence for blood draws

Kathy Kokotis 

 

Kathy Kokotis

Bard Access Systems

mary ann ferrannini
Kathy, Not all midlines get

Kathy, Not all midlines get a sympotomatic fibrin sheath or tail (at least that is the name I made up) or get a persistant withdrawl occlusion. The point I was making was that I have noticed that when we let the nurses have a free for all with blood draws we tend to get more occlusions related to the draw on midlines as well as overall decreased dwell times. I recently places a midline that lasted 6 weeks that I told the nurses not to use for draws. I found out that the last week before he was discharged they were using it for draws anyway and were able to get good samples. So....yes they often continue to draw....and some do not...but we like to discourage it if at all possible. 

 

fentanylius
Is there not a 4 week limit

Is there not a 4 week limit with midline catheters? I look forward to get a lecture from ferrannini again.

Andre

lynncrni
No, not really. I served on

No, not really. I served on the INS Task Force in the mid-90's that created this original statement. A midline catheter is indicated when the infusion therapy will range between 1 and 4 weeks. This was based on outcome data at that time for midline catheters. But it is not the same thing as stating that the optimum dwell time is 4 weeks. It is only stating that this is one factor to consider when assessing the patient for their candidacy for a midline. CDC guidelines clearly state that the optimum dwell time for midlines and all CVCs is unknown. This is because we do not have studies looking at the most appropriate way to analyze the dwell time - the Kaplan Meier Product Limit Estimator. For catheters, another way to consider this method is the point in time when 50% of catheters have failed from a catheter-related reason. The 72 to 96 hour dwell time for PIVs is based on this method. 

 

Lynn Hadaway, M.Ed., RN, BC, CRNI

www.hadawayassociates.com

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

clhunchusky
In my experience, midlines
In my experience, midlines are just long peripheral IVs and definitely will not provide a reliable lab draw source. Occasionally you will have one that does well, but definitely not generally as a rule. It is really not cost effective to tpA the line every time it doesn't draw. A PICC or other CVC would be a better choice if the pt needs frequent lab draws and has poor access to avoid uneccessary sticks.
mary ann ferrannini
 Andre,The purpose of the
 Andre,The purpose of the forum,in my opinion is to share and learn. From you post ("A midline is just a long IV") it seemed like you did not realize the limitations that a midline has.  I was just responding to your post and passing on my knowledge since I have no idea yourl level of experience and knowledge. Is your goal to learn and share? (that is mine)
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