We are considering trialing the power glide. Can anyone tell me if they are placing them in the lower arm or upper arm? If they are placed lower are you infusing vesicant medications? What type of criteria are you using to determine that a power glide is the best option for the patient? Does anyone have any data as to what percentage of patients you have placed a power glide where as you would have placed a picc prior to using the power glide? Any other information positive or negative would be helpful. Thank you.
Since it's a Holiday weekend there might be low traffic on this site. Hope you can find your answers by typing "powerglide" in the search bar upper right hand corner of the screen.
Have a great weekend.
Remember the Powerglide is a PERIPHERAL IV, and you still need to follow INS standards for PIV, so pH needs to be between 5-9 for any infusion. Just curious, why not just place a midline if your patient needs peripheral access for more than 5 days? It is cheaper.
Chris Cavanaugh, RN, BSN, CRNI, VA-BC
PowerGlide and PowerWand are both labeled as midlines. Therefore they should only be used as midlines, in my opinion. that means no placement in the lower forearm. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
I must be getting misinformed then. I was told that it can go in either the upper arm or forearm. I was told that it was only labeled a midline for reimbursement. I was also told that if placed in the lower arm and not in a deep upper arm vein that vesicants could infuse through it. We tried midlines here they did not work. The hospital I work in does not do well with changing so the few midlines we placed (and we only placed them when we were unsucessful placing a picc either arm) everyone got confused with them, one time we came in the next day tpn was infusing. Our ID doctor does not like them because you can't infuse vesicants and if the abx get switched and the line can't be used he is not happy about that. So we were told you could place them lower and infuse vesicants and then no one would think its a midline or picc because it is in the lower arm. So I was looking for feedback from anyone who is currently using them and how. Thank you.
I think you have been seriously misinformed. Look at the package insert and the slick brochure. Does it state "midline"? Here is the link to their webpage about this product
PowerGlide* Midline Catheter | Midline Catheters | Bard Access Systems
Product labeling is cleared for market by the FDA and that process does not include anything about reimbursement. I suspect this was a story that sounded good but made up to sell catheters. If you choose to use this at a site in the lower forearm, you would not be following the manufacturer's instructions for use and therefore this would be an off-label use. You and your hospital will assume all legal liability for your decisions and actions. A 3 inch long catheter placed in veins of the forearm would not be following the national standards of practice which states that the shortest length and smallest gauge should be chosen. Additionally, there is no published evidence supporting this practice for placing it in the hand or lower forearm.
Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
This is a great example of product information being spun to fit the circumstances, rather than looking at the facts of the product features. The lesson here is do not take a sales person's word, ask for the Instructions for Use. This is the approved by the FDA instructions and produt information that comes with each product. If it is not in there, it is considered off lable use. Off lable use puts your license, your hospital and your patients at risk. Bottom line, if you want to know anything about any product, the FACTS are in the Instructions for Use, that should always be your first resource.
Also, per INS Standards, any catheter that does not end in the SVC cannot be used to infuse anytihing with a pH below 5 or above 9. You can purchase a copy of the INS Standards from the INS website, if you need.
Chris Cavanaugh, RN, BSN, CRNI, VA-BC
This is a great example of product information being spun to fit the circumstances, rather than looking at the facts of the product features. The lesson here is do not take a sales person's word, ask for the Instructions for Use. This is the approved by the FDA instructions and produt information that comes with each product. If it is not in there, it is considered off lable use. Off lable use puts your license, your hospital and your patients at risk. Bottom line, if you want to know anything about any product, the FACTS are in the Instructions for Use, that should always be your first resource.
Also, per INS Standards, any catheter that does not end in the SVC cannot be used to infuse anytihing with a pH below 5 or above 9. You can purchase a copy of the INS Standards from the INS website, if you need.
Chris Cavanaugh, RN, BSN, CRNI, VA-BC
To my knowledge there is no professional or material reimbursement for a midline in placement or materials from Medicare. All VAD's for materials for Medicare regardless of their type on an inpatient are part of the DRG. There is no CPT code specific to a midline. The code used in IR is a PICC code for professonal labor that has not been able to be placed centrally so it has a modifier. There is no code for professional labor for a midline for Medicare on an inpatient or outpatient.
I suggest asking your billing departments at your facility to clarify reimbursement for materials and professional fees if the patient is non medicare. All providers vary by facility, placer etc.
You can find reimburement information at www.crbard.com. A midliune is not a central line.
Kathy Kokotis RN BS MBA
Bard Access Systems
We have successfully been using the Powerglide and are about to look at all our data to present for permanently keeping the Powerglide. Loose numbers, we have placed over 60 in the past 5-6 months with increase frequency over the past 2-3 months. We started very cautiously to define technique and what was needed additionally to place the Powerglide. Since the Powerglide is "a long PIV" we do not get a doctor's order because they aready have a order for a PIV and it is the Vascular Access team's decision to place or not to place these Extended PIVs verse getting a PICC. We mostly use them in upper arms, because most of our patients we use these on, have no good veins in the lower arm and advancing such a long catheter you may run into issues with valves or anatomy. Complications have been few, mostly dislodgement or clotting off. These are Saline flush only and staff nursing technique may contribute to this. I think we had just one Infiltrate and no DVTs. Since Vascular Access team places these Powerglides, we round and monitor these devices each day. Arm circumference measurements 8-10cm above insertion are done inital and with each dressing change and of course PRN.
Does this catheter decrease use of PICCs? Yes because before this Powerglide device came about, anyone with poor IV access, esp. also needing a CAT scan would get a PICC. PICCs are still needed but now we look at the need of a central placed line verse just IV access. PICCs are still a very important catheter, esp. for medications needing central line access and multiple IV drips. The Powerglide or other extended PIVs fill in the gap between infitrated PIVs and needing a PICC. We have had Powerglides in for just a few days up to almost 3 weeks, with no restart of PIV's. Some of the uses of Powerglides were on patients with very poor IV access and veins too small to accomodate a PICC line and getting IV fluids/medications not needing central line access. The Powerglides have been helpful in establishing stable IV access on patients with only one arm available to use because of dialysis AVFs and mastectomy patients.
Now as a side note, the company advertises, labs can be drawn off the Powerglides. We found that this is true initially for 24-48 hrs and maybe up to 4 days if you are lucky, then no blood return thereafter. If a patient needs freq. lab draws and has very poor IV access, I would do a PICC. We have not found these Extended PIV cathetrs holding up for blood draws, they are only a 20g catheter.
I hope this helps as you look at these new catheters.
Tracy Ivory, RN, BSN, VA-BC, CRNI
Utica, NY
Tracy W. Ivory, RN, BSN, CRNI, VA-BC
Faxton-St. Lukes Healthcare