Scenerio: Attending MD orders midline for a patient who will need 2wks of Vancomycin IV at home. Patient recently had a right sided chest port removed d/t infection. Positive blood cultures were drawn both peripherally and from port. Also has pocket infection. Has left chest pacemaker with recently confirmed DVT of left subclavian vein. Patient has CKD. Blood cultures have been neg X48hrs by the time midline order is received. PICC RN tells APN (we don't talk to attendings unless they are hospitalists) that Vancomycin should not be infused through a midline catheter for reasons we all know. Conflict ensues. Attending MD does not want ANY type of central venous access device because he does not want any risk of DVT that would preclude dialysis access. Not even an IJ picc as I suggested. Interventional radiology medical director (picc team based out of IR) orders picc nurse to place midline. States attending MD weighed the risk of vancomycin thru midline vs CVL placement be it PICC or IJ or any other CVL and it is his opinion that the risk of vanc thru midline is less than risk of thrombus formation from CVL. IR clinical nurse specialist informs me that it's not my place to say no to midline placement....it's not my place because I am not assuming the risk. The attending MD has made the decision and he is assuming all risk. By this time I've put in seven picc's for the day and I am developing a headache. Ultimately I did not place the midline because IR called the patient down at the end of the day. Any thoughts?