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?
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.
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
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, 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.
Is there not a 4 week limit with midline catheters? I look forward to get a lecture from ferrannini again.
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
Lynn Hadaway, M.Ed., NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Office Phone 770-358-7861
Cindy Hunchusky, BSN, RN, CRNI