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Picc line for long term ABX


I wanted to ask what is your practice and decision pathway for VAD inserted for long term Abx. Currently in our trust we are  experiencing increase in failure rate of midlines inserted for that indication. As far as we can check pH of drugs being given is not outside recommended range (5 - 9) but only thing which comes to my mind at the moment is chemical thrombophlebitis from long term infusion to peripheral vein. Those leaks from insertion site (assumed VTE) occur despite good position of the line tip and following all ZIM guidelines. MAGIC decision tool recommends PICC for abx course longer than 2 weeks. What is your practice? There was a suggestion that it may be an issue with the brand of lines we use but we can not see why it would be the case.


Many thanks 



Not the brand of the device.

Not the brand of the device. What is your tip location - midline or midclavicular? Should never be left in the shoulder joint area?? Are you meauring catheter to vein ratio and inserting a size that will consume less than 45% of vein lumen? ALL drug characteristics must be considered, not just pH. Include osmolarity, etc as listed in INS SOP on VAD Planning. What are you calling "long-term ABX"? 

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

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

Thank you for coming back to

Thank you for coming back to our question.

As mentioned in my post, location of the tip is below the axilla and we observe ZIM rule along with the catheter to vein ratio. We have not found any irritant or high osmolarity PN being infused via our midlines. I wanted to ask about your experience-if the   length of abx course (allowed to be given peripherally) can affect the risk of chemical phlebitis. We are discussing an option of inserting single lumen picc if predicted length of abx course is more than 2 weeks. When you check Magic (Michigan appropriatness guide for intravenous catheters) it is said that for  antibiotics given iv, picc is the preferred device if course is predicted for more than 2 weeks. So I am wondering what would be your advice as online I found only well known guidelines regarding osmolarity, pH and practice of inserting midlines(tip position and zone insertion method).



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