Midline catheters?

[Everlearningnewbie]

Nursing student here just finishing preceptorship and I need a little clarification on something. I understand the basics of PICC's and midline catheters but I had a confusing experience today. So with power piccs they don't need to be clamped because they have mechanisms inside to stop blood flow. Hickmans always need clamped when not accessed because they lack this mechanism. Same with midline catheters. However, I had the experience today where a pt had a midline catheter but the cap was directly against the insertion site , no tubing was extending and there was no way to clamp anything off because it was simply the cap. After administering blood, the cap was filled with with blood that couldn't be flushed so the cap needed changed. So the nurse set up her sterile field and twisted off the cap and blood started just flowing out. She was able to quickly get on another cap but obviously she hadn't expected that to happen. So my question is, have you ever seen a midline catheter without clamps or any tubing extending? How are you supposed to go about changing the cap on a midline catheter like this? Can you even? I haven't had any experience with midline catheters, let alone one like this and all the nurses were perplexed by it so I'd just love to have some clarification. Thanks!

[IVRUS, BSN, RN]

First of all,

There are two types of Catheters: Valved and Non-Valved. Valved catheters have a valve either at the distal end of the catheter (LIKE A GROSHONG) or at the proximal end of the catheter (LIKE A SOLO POWER PICC) ALL valved IV catheters only require flushing with Normal Saline solution and Heparin isn't needed. Non Valved IV catheters should be flushed with Saline and Heparin Flush solution. Now, I know many places have policies which increase the frequency of their flushing and omit Heparin flushing, and that is there choice.

However, Erroneously, some NON-VALVED IV catheters will be lacking a clamp. IF a catheter is lacking its clamp, the clinician should add an extension set which has a clamp on it so that one can change the Needleless connector at intervals, namely to avoid the situation you described in your post.

If an IV catheter is valved, the valve will stay closed as long as negative or positive pressure isn't placed on the IV catheter, therefore no blood back up, or air embolism is had with a functioning valve. In the case you described, one had an open-ended, non-valved IV catheter, and an extension set with a clamp should be added to safely remove the cap while the catheter remains clamped. Or, the IV catheter should be pinched off BEFORE removing the cap.. But it is so MUCH easier to add an extension tubing with a clamp!

A midline IV catheter, just like all central lines, can be valves or non-valved. The only type of IV catheter I place are Groshongs. I place Groshong Midlines and PICC's. They are valved, and do NOT have a clamp as an integral part of their design as its not needed.

[nutella, MSN, RN]

I wonder if the clave was simply missing.

Of course if you just put the midline in, no clave, and just a cap the blood will flow out when you remove the cap.

[IVRUS, BSN, RN]

No,

Blood will NOT JUST flow out when the cap is removed if the IV catheter is VALVED.

[nutella, MSN, RN]

No,

Blood will NOT JUST flow out when the cap is removed if the IV catheter is VALVED.

Yeah but we do not know if it was valved... plus what if a valve is broken???

[Everlearningnewbie]

Thank-you very much for your detailed response, that makes a lot more sense now!

[IVRUS, BSN, RN]

Agreed,

But we also cannot make a blanket statement saying that absolutely blood will flow out of the IV catheter if the cap is removed. Because if it is Valved, 99.9% of the time, it will not happen. Now, can the valve malfunction, Yes, but it is very rare.

There are incidental reports which found a valve may become incompetent or may have a fibrin plug keeping the valve open, but again, this is a rarity.