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Midlines placed in ICU

We are a large university hospital with over 500 beds between 2 sites. Due to an increase in CLABSI rates in our ICU's the medical director is pushing extremely hard for midlines to be placed in the ICU. Currently we do not place midlines at all in our hospital due to the potential for misuse and extravasation. If midlines are going to be initiated we fear that the ICU is NOT the place to trial due to the exceptionally high risk for extravasation from the extensive number of vesicant medications and continuous drips that are utilized in that setting.

I need any articles and/or data showing the risk of midlines especially in the ICU setting. Unfortunately once the ICU has access they have shown in the past that they will use it regardless of it's limitations or contraindications. When a patient is critically ill and they need access they will use any and all access when it is available without consideration of consequence to the patient. We are trying desperately to prevent this and need your help in providing any information showing midlines in an ICU setting are dangerous.

Your help is greatly appreciated!

Hi Keviin

prevention ...prevention...prevention..

jill nolte
midlines are not dangerous. lack of education is dangerous.

device selection is based on patient and therapy, not location. I put midlines in the ICU when appropriate because I believe we need every tool in the box to take care of patients.

Buck shot

I do agree with Jill. Midline's are not dangerous, just useless in how they are being used. Every ICU patient should have a CVC until they can have it replaced with a PICC. Then you should downgrade to a Midline as the patient moves out of ICU onto the floors. That is what makes sense. The reason that common sense approach is not happening, is because hospitals are be financially spanked for CLABSI's. OK fair enough. The problem is one knows WHY the CLABSI's are happening. Physicians, Nurse managers, nursing leaders, have no idea how to defeat this. So, what do they do ?...Buckshot....If you shoot it with Buckshot you just might hit the cause. But that is a wrong approach, but who is going to stand up as a vascular access clinician and scream that this won't work?
No one. So on we go prematurely eliminating central lines in an ICU and subjecting the patient to stick after stick after stick. If you are a clinician working in an ICU setting , you absolutely know what I'm talking about. The answer to the problem that everyone dances around is SHODDY CARE AND MAINTENANCE. If nurses became bulldogs with care and maintenance you would see a huge drop in CLABSI's...and yes Jill there are studies that show that. So, IMO, If you don't want CLABSI's ....then don't have CLABSI's!!. So, Kevin. I'm afraid this won't go away anytime soon but I can still hope.

Midlines in the ICU

Kevin, I feel your concern (and pain) in this matter.

While I agree that midlines are not essentially dangerous, they can have potentially significant deliterious effects on the patient, and in an acutely ill, critical care patient, it is paramount we try and reduce risk of potential complications. A midline will NOT do this.

Replacing a CVC with a midline in the ICU to prevent CLABSI is essentally foolish - especially if you believe that it's going to just save money. Yes, that maybe so initially, but it is at the expense of the patient and the costs involved with now treating their complications (in a longer term view).

If ALL clinicians, not just our VA peeeps, made the approriate decisons in placing devices in critical care areas correctly, as well as maintaining a high standard of care and maintenance for these devices, and assessed whether the device was actually needed or not would reduce CLABSI in the ICU.

I find it amazing that institutions have a knee-jerk reaction to a problem, and blame the device first.

Lets first actually have a look at what is actually happening in our backyard before we start making often unneccessary, and at times, inapprorpriate decisions based on poor decision-making processes but uninformed or out-of-touch staff.

Midlines have just as much risk for infection as a PIVC, as a midline is still a peripheral vascular access device. Often the insertion techniques for these devices are questionable, especially if using an AST over MST technique.

I would be certainly burning the midnight oil looking at midlines and the issues that arise from them.

All is not shny in the world of midlines, and as a reguar presenter on midlin issues around the country (USA), there is ALOT to be gained from even getting clinicians to use the device correctly, let alone the amount of education required to inform the grassroots of our workforce who care for these..

Not all cares are done by the wonderful VAT's and infusion therapy teams - many are often left to the bedisde nurse, who in many situations, has a poor knowledge and concept of midline use, let alone being able to even tell the diffeernce between an midline and PICC at times.. Frightening as it seems, this is the reality in this country today, as my shoeleather surveillance does not trick anyone - the more I see and hear, the more I think we have HUGE inroadds to make alone in education..

Lots of work ahead no doubt, but I'm hopeful that clinical decsions and education will prevail, and help rationalise the use of at times, inappropriate midline use in a critical care unit!.

 If you need any help with this, feel free to message me with any questions - I am happy to help.



Timothy R. Spencer, RN, APN, DipAppSci, BHealth, ICCert, VA-BC™

Vascular Access Consultant

E: [email protected]

M: +1 (623) 326 8889 (USA)

M: +61 (0)409 463 428 (AU)

ABN: 51606547370 

Timothy R. Spencer, RN, APN, DipAppSci, BH, ICU Cert, VA-BC™
Vascular Access Consultant
That CVC guy from Australia :-}

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