Midline IV

Daytonite, BSN, RN · Mar 25, 2009

this is the ohio lpn nursing law pertaining to iv therapy: http://codes.ohio.gov/oac/4723-17

you can do anything with them that you can do with any other iv in the state of ohio. a midline iv is a peripheral iv. if you need information about ivs, there are all kinds of informational weblinks on post #5 of this sticky thread for the nursing students: https://allnurses.com/nursing-student-assistance/any-good-iv-127657.html - any good iv therapy or nursing procedure web sites

http://www.drugs.com/cg/peripherally-inserted-central-catheters-and-midline-catheters-discharge-care.html - drawing on page illustrates the difference between the length of the picc and midline iv catheters once they are in place
http://www.hrmedical.com/catalog/category/midline-catheter-kits.html - photo of midline catheters alone with measurements

*IV* · Apr 25, 2009

A Midline CANNOT infiltrate. It is impossible! Swelling could be mechanical phlebitis, DVT, infection. Risk of infection is no greater than PICC, which is less than 1% if proper care is given and dressings are changed properly. Midlines are used a lot, We insert hundreds of them in LTAC hospitals and Nursing Homes. They can remain in 6-8 weeks, longer if site is aysmptomatic and line is functioning well. It's case by case. Also,

UM Review RN, ASN, RN · Apr 26, 2009

OK, someone needs to enlighten me as I took the IV course a long time ago:

1. We were taught that midlines could infiltrate, and I have seen them do so.

2. I was taught that due to the type of material used for the line, you could not draw blood or infuse things like Vanco through the midline (which you can infuse with a peripheral).

Anyone care to educate me on the whys and wherefores?

*IV* · Apr 27, 2009

No, a Midline CANNOT infiltrate. It is absolutely impossible. An infiltration is caused by a short catheter (peripheral) that has leaked out of the insertion site into the tissue or the vein was penetrated by the needle causing an immediate swelling.

A Midline is 20 cm long (about 8 inches). It terminates near, but should not be past the axilla. Midlines are used for many reasons; therapy length is the biggest reason. Vanc can and is run through a Midline, although it is highly discouraged by the CDC and INS as it is a vessicant drug and can cause problems. PICC lines are best for Vessicant drugs as terminating in the SVC, the hemodilution factor reduces complications. The material that a Midline is made of is the exact same as the PICC. The ONLY difference is that a Midline is 20 cm and a PICC line comes usually 65cm long and is cut to length. You can actually trim a PICC to 20 cm to make it a midline.

Also, blood draws are possible, but not a guarantee due to the gauge of the line. Usually I will put in an 18 gauge if I know blood is being drawn from it. There is a risk of hemolyzing your specimen if you try to draw from too small a line.

IVRUS, BSN, RN · Apr 27, 2009

A Midline CANNOT infiltrate. It is impossible! Swelling could be mechanical phlebitis, DVT, infection. Risk of infection is no greater than PICC, which is less than 1% if proper care is given and dressings are changed properly. Midlines are used a lot, We insert hundreds of them in LTAC hospitals and Nursing Homes. They can remain in 6-8 weeks, longer if site is aysmptomatic and line is functioning well. It's case by case. Also,

Whoa...

Let me clarify things! A MIDLINE OR A PICC CAN INFILTRATE!

Any VAD can!

Whether the precipitating events include a mechanical force which displaces the device, or an obstruction of blood flow around or through the catheter, an infiltrate, or in the case of a vesicant drug, an extravasation can occur.

Once the SQ tissue is exposed to the escaping fluid (It could be that the vessel has lost its integrity and therefore is allowing the permiability of the solution such as in the inflammatory process which causes the endothelial cells to retract and fluid to leak, or in the case of the catheter eroding through the vessel wall) damage is caused by osmotic and pH differences, ischemia or compression.

In addition, appropriate dwell is 2-4 weeks... Not that it can't stay in longer but standards of care should be taken into account!

DD

IVRUS, BSN, RN · Apr 27, 2009

OK, someone needs to enlighten me as I took the IV course a long time ago:
1. We were taught that midlines could infiltrate, and I have seen them do so.
2. I was taught that due to the type of material used for the line, you could not draw blood or infuse things like Vanco through the midline (which you can infuse with a peripheral).
Anyone care to educate me on the whys and wherefores?

Angie O'Plasty,

Vancomycin can be given through a Midline, but it isn't the wisest thing to do. As I mentioned in a previous post,

given the damage that this vesicant can do to the smooth, Tunica Intima, by the time a complication is discovered, much damage has already been done!

In addition, most Midlines are 3fr, and therefore, you would not want to draw blood from them as they are prone to frequent clotting when doing so. However, a 4fr midline may yield a better flow and if a facility is using it for blood drawing as well as medication administration, I will place a 4 french Midline, but I will encourage PICC placement due to its greater reliability.

Hope this helps!

DD

UM Review RN, ASN, RN · Apr 27, 2009

Angie O'Plasty,
Vancomycin can be given through a Midline, but it isn't the wisest thing to do. As I mentioned in a previous post,
given the damage that this vesicant can do to the smooth, Tunica Intima, by the time a complication is discovered, much damage has already been done!
In addition, most Midlines are 3fr, and therefore, you would not want to draw blood from them as they are prone to frequent clotting when doing so. However, a 4fr midline may yield a better flow and if a facility is using it for blood drawing as well as medication administration, I will place a 4 french Midline, but I will encourage PICC placement due to its greater reliability.
Hope this helps!
DD

Got it. :idea:Apparently the size of the midline must've had something to do with that because our policy stated that we were not allowed to draw blood from anything smaller than a 5 fr. Thanks for clarifying.