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Andrew Mackler
Using ultrasound and/or MST for midline placement?

I am revising a guideline for midline placement and a policy for midline maintenance and removal. Some members of the IV/PICC team are questioning the use of ultrasound for placement for midlines as well as using MST for insertion. The general feeling is that if you need to utilize a "modified" technique to achieve midline placement you might as well insert a PICC. I realize that the procedure is based on personal preference, but I looking for feedback on whether other IV/PICC teams are using ultrasound guidance and/or MST for midline insertion. Thanks!

Andrew Mackler, RN

Venous Access Consultant, BIDMC, Boston

well we do use MST for
well we do use MST for Midlines...for a couple of reasons...first vascular access is near impossible, infusion needs are short in duration, or obtaining blood samples is difficult...we are careful to review the infusates, INR...and it will over all cost less(than multiple sticks)
T. Nauman RN, CRNI  IV

T. Nauman RN, CRNI  IV Educator SHMC Eugene, OR

We use MST and ultrasound for both PICC and midline placement...mostly because we're used to the procedure.  We place very few midlines, however.  If we can see or palpate a good vein at the a/c, we might not use MST etc., but often the veins aren't that good.  It is left up to the discretion of the nurse.

T. Nauman RN, CRNI

Kathy Kokotis Bard Access

Kathy Kokotis

Bard Access Systems

 Why would one ever place any VAD without ultrasound?  Soon peripheral IV's will be placed with ultrasound.  Expanding the horizons is always the goal.  The next question is how useful is a midline and I used to work fo MenloCare for two years?

Kathy Kokotis

Bard Access Systems

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