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PICC or midline in fractured arm

Not sure if this has been asked, but one of my coworkers recently placed a midline in a fractured arm. This patient happened to have fractures in both arms and needed access so my coworker placed a midline and a lot of us had questions about this. We did some research and only found contraindication for a fractured arm, but what if both arms are fractured? what is the appropriate line for this patient and is there any evidence to support that decision? What if CL could not be placed? What do we do?does anyone have any good advice for this situation? Thank you

There are numerous locations

There are numerous locations for a fracture of an arm but you did not say exactly where this fracture was located. Simple or compound fracture? Any issues with circulation in the broken extremity? What was the vascular access for? For how long will it be needed? Is a central line truly needed for the type and length of therapy prescribed? You might find a case report about a VAD in a fracture arm but I doubt it. So this decision is made based on your assessment of the patient. A simple fracture in the wrist or low forearm without any swelling or compromise in circulation might be able to tolerate a midline or a PICC. But a fracture of the humerous would be NO. In this scenario you might be able to place a long PIVC in the lower forearm if there is no other site. If a CVAD is not needed, you might be able to manage with some type of PIVC, preferably a long one due to their added stability. 

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

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

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