Midline IV

A midline IV is a peripheral IV catheter with a significantly longer cannula than normal-- 6 or more inches.

It tends to last a bit longer and is a bit hardier than a normal peripheral.

As previously mentioned - a midline catheter is a peripheral IV (ie not a central line). The tip (or end - where the medication infuses) - is in the mid basilic/cephalic vein - it does not extend past the axilla. They usually are about 20cm long - and are intended for long term peripheral access (up to ~6 months)..because they are not a central line - they should be used for non-vesicant infusions and are not suitable for blood draws - if they require either of these, they should have a PICC or other CVC placed. Midlines aren't used much anymore as PICC's are becoming more abundant - PICC's usually are a better choice - longer life, more functionality etc...

Brent.

Yeah, I've never actually seen a midline.

However, we do have these 2.5-3 in. cannula peripheral IVs we occasionally put in with ultrasound guidance here in ICU. No MD order needed. I guess they're mini-midlines.

We do occasionally still see a midline, either when the PICC was unable to ba advanced far enough and any line is better than no line, or if the PICC was pulled out on accident. We also do not use them for blood draws and I much prefer a central line or a PICC.

OP if you are a nurse you should have no issue using a midline, I have never heard of them being off limits?!

I've seen lots of PICC's and lots of midlines. I maybe where I'm at it is a little different. It seems like the midline catheters are the same as the PICC's, only they're placed in the AC area. I know that when I d/c them they look exactly the same. Only since they are placed lower, they don't go in completely to the SVC opening. Maybe I am wrong. I should watch the guy the next time he puts in a midline. or ask him..

The hospital I work at has had a big push lately to use midlines vs. PICCs. I have no idea why, I don't like them at all. And we do draw blood off them, which makes NO sense to me because its just an IV, same as a peripheral IV only longer.

Midlines are still very popular in LTC. They can be inserted at bedside and don't need an Xray for placement checks..much cheaper than PICCs.

Check your facility P and P for flushing and dressing changes.

Are you asking if LPNs can work with these? In PA, yes...

Midlines are the critter of choice at our facility because of the elimination for xray verification of placement. We don't always have a Doc available to read the xray. Dilemma is: do we delay the antibiotic until a doc shows or start a PIV which does a deservice to the patient. Obviously, we are going to get the antibiotic on board but it is still a delimma.

FWIW, Dave

I was told a long time ago by an IV nurse that midlines had a much higher risk of infection and infiltration, thus why we didn't use them anymore.

Tait

I rarely see midlines these days.

As previously mentioned - a midline catheter is a peripheral IV (ie not a central line). The tip (or end - where the medication infuses) - is in the mid basilic/cephalic vein - it does not extend past the axilla. They usually are about 20cm long - and are intended for long term peripheral access (up to ~6 months)..because they are not a central line - they should be used for non-vesicant infusions and are not suitable for blood draws - if they require either of these, they should have a PICC or other CVC placed. Midlines aren't used much anymore as PICC's are becoming more abundant - PICC's usually are a better choice - longer life, more functionality etc...

Brent.

Infusion Nurses Society (INS) recommends that the dwell time for Midlines be 2-4 weeks.. I would never leave one in for 6 months. Yes, they are just a long peripheral (> 3 inches, but less than 8 inches) and because they don't extend past the axillary vein, a CXR is not needed as there is no chance that it will have entered the Right Atrium... It is not a Central IV Catheter, like a PICC is. In some places, like LTC, you may find many Midlines as many times you are infusing isotonic, or near isotonic IV fluids, or IVAB which aren't irritants or vesicants.

The big problem with Midlines is the fact that if one infiltrates, because the vessels where the tip terminates lies deep within the body tissues, it will not show s/s until significant damage is done (that is if you have an asphasic pt).

And yes, PICC's are a better choice because of the longer life, and the fact that it is a true central IV catheter.