[ghostcat]

I am curious if any of your facilities are doing midline PICCs - especially if nurses are doing them independantly at the bedside. We are trying to institute this at our facility for the patients who are running out of veins, or who are receiving something hard on veins, but doesn't necessarily need a PICC - won't need access long-term, no TPN....
Our medical director is an interventional radiologist who likes to have control over the PICCs and is fighting nurses doing this.

[Binkey]

Okay Ghostcat..
I'm a little confused here. Are you asking about a midline catheter which is not a PICC as it terminates in the upper arm before the axillary vein (6-8 inches long) or are you talking about a true Peripherally Inserted Central Catheter (PICC) which terminates in the SVC?

[ghostcat]

Sorry- I'm talking about midline catheters - we tacked PICC on the name (admitttedly inappropriately) when talking to people who didn't understand what we were talking about to explain why it would take longer then a regular IV start and would generate a nurse charge, and also why it can be used differently than a regular PIV (and differently than a PICC).
In our facility PICC placement was taken down to radiology. They still use an IV nurse to do the placement, but our department gets none of the revenue and it is an amazingly expensive procedure because the radiologist (who usually just stands there watching and verifies placement on the flouroscope) charges a physician charge. Some patients are getting PICCs for just a few days or a week because they need access, and we are unable to get or keep a PIV in. This seems like a waste of money. In addition, the nurses on our IV team who don't want to sit in radiology all day in a lead apron, would still like something to do that is a little more challenging than PIV starts, line draws and central line flushes.

[ghostcat]

Sorry- I'm talking about midline catheters - we tacked PICC on the name (admitttedly inappropriately) when talking to people who didn't understand what we were talking about to explain why it would take longer then a regular IV start and would generate a nurse charge, and also why it can be used differently than a regular PIV (and differently than a PICC).
In our facility PICC placement was taken down to radiology. They still use an IV nurse to do the placement, but our department gets none of the revenue and it is an amazingly expensive procedure because the radiologist (who usually just stands there watching and verifies placement on the flouroscope) charges a physician charge. Some patients are getting PICCs for just a few days or a week because they need access, and we are unable to get or keep a PIV in. This seems like a waste of money. In addition, the nurses on our IV team who don't want to sit in radiology all day in a lead apron, would still like something to do that is a little more challenging than PIV starts, line draws and central line flushes.

[pricklypear]

In our hospital, nurses start all midlines. If they can't get one, the patient goes to radiology and a PICC is actually put in by the radiologist himself. We have a certification class, and them you have to be witnessed a number of times until you can do in on your own. At my former hospital, our IV team (all nurses) inserted PICCs all the time, they were only left as midlines if they couldn't be advanced any further for some reason.

[Bsea2]

Hi Ghostcat, I'm a home infusion nurse. We put in midlines for therapies scheduled to run longer then 7days, or as you mentioned if pheripheral access is limited. The thing you have to remember is that a midline is still a pheripheral line it is not central. Although it does have extended dwell time (4-6 weeks) it can not be used for vessicant drugs or blood draws.

[jmgrn65]

In my hospital we have some nurses that are picc certified, they have a small ultrasound machine to insert and sometimes they get a port xray to verify placement but they look at placement and tell us if it can be used.

[ghostcat]

Originally Posted by Bsea2

Hi Ghostcat, I'm a home infusion nurse. We put in midlines for therapies scheduled to run longer then 7days, or as you mentioned if pheripheral access is limited. The thing you have to remember is that a midline is still a pheripheral line it is not central. Although it does have extended dwell time (4-6 weeks) it can not be used for vessicant drugs or blood draws.

I knew you couldn't use them for things like TPN. Do you use them for meds like Vanco that are hard on veins, but are often given peripherally. If so, do you find that they are less irritating through a midline?

[Binkey]

Ghostcat,

Thanks for clarifying the previous info...
At my place of employment we service approx. 300 LTC facilities and often place midlines in pt's who have less than 4 weeks of Vanco left.
If however, the pt has > 4 weeks, we place a PICC line.
The midline catheters work quite well for this therapy, and even though Vancomycin is a vesicant ( pH of 2.5 - 4.5) we aren't seeing the phlebitis & other complications that are usually associated with catheters less than
3" in length.
INS stated in their latest issue of Newsline..
"Some medications (like Vanco) that meet the criteria for CVC access devices can and are given on a short term basis via peripheral or midline IV catheters."