Any thoughts on transfusing RBC's via a 4 fr midline catheter? I have not found any literature to discourage the use of a midline for transfusion in a nursing home. Many homes don't want PICC's placed unless we show them documentation for appropriate use of midlines. I always encourge PICC placement for Vanco, Imipenem, Meropenem, Nafcillin, etc, but some of my co-workers think that a midline should not be used for RBC's. I have found no literature supporting their view. One nurse told me that INS states that you should not transfuse via a midline. I went fthrough all the standards and found nothing stating that. It's an extended dwell peripheral catheter that is in the peripheral vasculature so I see no reason not to give RBC's through it. Any thoughts, or literature to support or contraindicate this use?
Thanks, WW, CRNI, VA-BC
I agree with you. I cannot see any reason for not using a midline for a transfusion. Blood is not a vesicant or and irritant. My greatest concern would be that the transfusion may take too long to be administered and the midline frmay block. I guess that if that was the only access that I had, I would use it.
France Paquet, RN, M.Sc. VA-BC
McGill University Health Center
France Paquet, RN, MSC, VA-BC(TM), CVAA(c)
Clinical Practice Consultant, IV therapy and Vascular Access
Transition support office
McGill University Health Center
Montreal, Quebec, CANADA
Thank you for your response. There doesn't seem to be a problem with duration of transfusion. The MD usually orders each unit to be given over 4 hrs and they follow that order. Some patients have peripheral short catheters for transfusions, but with this population many have poor venous access. Midlines are more reliable access and that is why occasionally midlines will be placed.
Warren Willard
I see no reason for ruling out a midline. But, I am concerned that a nursing home would provide a transfusion. Do they have skilled staff and policies that would support this practice? If the believe INS standards rule out using the midline, what other misconceptions do they have?
I have seen nursing home patients undergoing transfusions at out patient clinics and line maintenance at the nursing home. That seems more reasonable.
Ann Zonderman, BSN, JD, CRNI
Thank you for your input. Actually these homes transfuse routinely and do it quite well. They follow strict procedures which are established by their pharmacies. We use to do the transfusions for them, now some places do them using their own staff.
Warren Willard RN,CRNI,VA-BC
There is nothing in the Infusion Nursing Standards of Practice prohibiting the use of a midline catheter for transfusion of blood. The only thing I would add is that the length of a catheter adds resistance and would slow down the rate. So the length of a midline or PICC or any CVAD would cause a rate much slower than a short peripheral catheter of the same internal diameter. This would mean the use of an infusion pump that is labeled as safe for the transfusion of blood. 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