I work in an LTAC (long term acute care) hospital, and recently there seems to be a big push for trying to replace PICC lines for midlines. The rational behind this is to help reduce infections. What are your thoughts, and do you have any research articles that support this?
If you mean an overwire exchange to remove an existing PICC and insert a midline - this is definitely not acceptable or needed and should not be done. If you mean inserting a midline instead of a PICC from the beginning, there is a growing body of evidence about that and addressed in an online course we will be releasing next week. It requires a careful assessment of what is prescribed and numerous factors to determine if a midline is appropriate or not.
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
Hi Lynn,
To clarify this would be a patient who may have been on an antibiotic or two that required a central line, then all of a sudden they are on an antibiotic that does not require a central line. Then we will pull a good picc line and switch it with a midline as a new insertion (not an over the wire). I feel its more along the lines of what Jack mentioned, because that accountability, and reporting. The course that you speak of, does it cover this topic, or choosing a midline instead of a PICC as your initial insertion choice?
Thanks
Dominic
There are studies that assessed removal of CVADs and insertion of midlines, using strict criteria. These are discussed in the new midline course, which is available on through our website in my signature.
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
Good question Dom,
Sadly, this is true. But don't be fooled thinking there is any reason other than money and good outcome scores. Sure the sideliners will tell you that is a good thing and we sould all be looking to get out these lines. What they WON'T tell you is that 6 years ago or so, every hospital fought to have PICC'S inserted. It meant quick turn around, meds and labs done at prescribed times and if need, the patient could go home with IV ABX. So what changed? Accountability! Hospitals are now accountable for CLABSI. Financially they are being punished. So we all know what that means?....It's funny, ask yourself this?...If a Midline and PICC have the same infection genesis......why is it OK to place Midline after Midline in the same patient? Is CLABSI prevention REALLY what we are trying to accomplish?.....when you can answer that, you'll have the real truth.
That is why I am struggling with this. They say its for CLABSI reduction, but is it really reducing infections? One thing I can say for sure is that it is reducing reportable infections. I did a quick search on research articles, and didnt find anything that was solid, but I will be digging in a little deeper here soon.
Thanks.
Now your getting it Dom
There is one study that focused on appropriate criteria for removal of CVADs in critical care patients and insertion of midlines and did report legitmate CLABSI reduction. This is thoroughly discussed in my online midline CE course.
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
Yep. It will definitely reduce CLBSI's. There is no question about it. But will it reduce CLABSI because it's a better access?..or because Midlines are not devices that must be blamed for CLABSI's...So, if Midlines can't be considered for CLABSI reporting, then technically, they can't CAUSE a CLABSI.
My thoughts exactly! It's not like PICCs and Midlines reside in a different bloodstream!
After finally bringing midlines into our institution, I am displeased with the outcomes. I can't wait for the course from Lynn Hadaway. I have found little in the literature that addresses midline complications.
Nancy Rose