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Gina Ward
MIDLINES with Vanco infusions

I am reviewing the new Infusion Therapy Standards of Practice regarding Midlines. It appears, if I am reading it correctly, that it is ok t select to insert a Midline if a pt. is receiving intermittent Vancomycin.

1. we do not anticipate the Vanco to be given greater than 6 days
2. We monitor closely for vein irritation and extravasation.

I know the statement regarding the Ph of the drugs has been since removed, when making a selection of Midline as appropriate line for insertion. So, that also would make it okay to instill Potassium, Phenergan etc.... with the same precautions since all will be intermittent. Is that Correct??

How is everyone else making their selections on this?? We just started doing Midlines and I want to start and continue to practice according the relevant standards.

Thank you in advance!

Gina Ward R.N, VA-BC

 Not quite the correct

 Not quite the correct interpretation of what is written. Yes, the parameters of 5 to 9 for the pH was removed because there is no evidence to support those parameters. Concern about pH and its relationship to venous irritation and complications went into the SOP in the late 1990's based on several articles putting forth the pH factor as a theory. Now we know that research does not support using these parameters. But infusate characteristics must still be considered and pH is an infusate characteristics. "less than 6 days" is only an example following the statement about anticipated duration of therapy. This does not make a prescriptive statement that therapy has to be limited to 6 days. Every infusion has to be monitored for vein irritation, so nothing different for vancomycin. Since research has not completely answered this question, note that this statement has a ranking of IV, which is a low level and requires critical thinking based on your complete assessment of the patient, infusate, venue of care, etc. This is not meant to open the door for infusion of other known vesicants like promethazine through a midline. You can learn more about ALL research on midlines in my online CE course on Mildine Catheters. Get more information at

Several older studies document infusion of vancomycin through midlines from the early 1990's. This course includes evidence tables with data from all these studies. Lynn

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

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

Natalie F.
Vanco + midlines = bad

Vanco + midlines = bad

If you're going thru the trouble of a midline, put in a PICC.

How would anyone ever know if a patient will respond to treatment in 6 days of less.

Gina Ward
Thank you very much Lynn.

Thank you very much Lynn. I understand what you are saying.

Gina Ward R.N., VA-BC

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