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
The person that did PICCs at my institution prior to me, told me of this practice. She cut the POWER PICC to be used as a mid-line. I contacted BARD clinical support, and of course they said if this is done, it would definitely be "off label" and if anything happened it would be bad for me. I have always had questions in my mind about this practice both pro and con. Wondering why Lynn said she would never do or recommend this practice? Is it strictly because it would be off label use?
I have a cardiologist that has an aversion to central lines placed either subclavian or IJ and frequently orders "mid-line" for his patients particularly those with pacemakers despite the fact that the pacemakers are not new placements and we use opposite side. My concern always is that I place it as a mid-line now, pt goes bad and people start using it for Dopamine and other drugs that should be central. We go round and round.
Definitely interested in what others think.......
I have been told by Bard that the Power Picc is trimmable to midline length. As far as injection I suppose there has been some question to off use and Bard said not because of the catheter not tolerating the injection but risk of infiltration. When injection in CT thru a short peripheral line needing to use an anticubital vein is a longer IV more stable than a 1 inch line. Especially if the patients veins run deep. Just a thought. Of course I was originally told by Bard no problem to inject thru midline length and have just recently learned of the possible off use label.
Speaking from medical imaging standpoint and a nurse who deals with contrast infiltrates, I can absolutely, with no hesitation in my voice: do not power inject midlines, even though they are power injectable!!! Contrast has an osmolality of 650 or greater and is injected at 2-4ml/second with a power injector
. You really want to deal with extravasated contrast in the auxilla? Try explaining this one to the legal nurse consultant sitting across from you. You can't.