would you insert midline if

[luvrn]

If a patient's arm you were going to use to insert midline was slightly swollen and bruised right below the shoulder would you still insert the midline. This patient is at home, not the hospital. The arm is also painful to move so patient has to assist it with the other arm. Unable to use the other arm r/t IV infiltrates.

[smoo]

It's really hard to say without actually seeing the arm, but when I took my midline placement class, that was one of the things they said to watch for and probably not place into the arm. Hopes this helps some, as I said though, without seeing the actual arm, I can't really say for sure.

[luvrn]

Thanks Smoo, hard to find information on the internet re: different scenerios on PICC/Midline placements.

Thanks again

[Mic H.]

I think the first question should be is a midline the right catheter for this patient? From the little I have read in your information this patient has infiltrates that prohibit short peripheral placement. If you place a midline in a major vessle above the AC and infuse the same fluids through it you may set the patient up for damage to his basilic or cephalic vein which would be difficult to differentiate early due to the pain that the patient is already experiencing. So, depending on what you are going to infuse the patient may benefit from a PICC line. I know that it is not yet possible to place a PICC in the home due to x-ray verification needs but the wrong line for the patient is not the best practice either. Next, if the infusates are not the problem, it may be possible to place a midline using ultrasound and MST, but without seeing the patient it is difficult to assess and again it would be difficult to differentiate pain r/t new catheter and pain r/t previous injury. Hope this helps, Mickey

[PICC ACE]

Mickey--some very good points. I wouldn't give this patient any line without a more in-depth asssessment,including some sort of study of the veins in both arms,even if it's just with portable ultrasound. The 'infiltrated' arm may be OK if the infiltrations are resolving and the veins are OK,but if there is any thrombus in the veins,then not. The reasons for a swollen area in the other shoulder could include a thrombosis in a major vein,or the swelling could lead to a situation that increases the risk for thrombosis. IOW,no easy answer,but either way I'd be reluctant to use either arm without further assessment.

[luvrn]

Thanks everyone for their help. I just didn't think it was right to insert it, but the MD said it would be OK...still didn't insert the midline. Thanks again everyone.