Midline Usage

We don't use them hardly at all! Can't give anything extravasating through them, can't draw labs, can't tell if they've infiltrated. BSI or not, they are a bad idea as far as I can tell. Interesting idea though. Are they not considered a central line? 

I don't like them much myself. My facility makes it too easy for the floor staff to call for a midline placement without ever attempting PIV access. We try our best to minimize midline insertions but there is a strong push from hospital administration to remove central lines and insert midlines instead. The floor staff seems to perceive that midlines "are just like peripheral IVs" because that is what is being fed to them from hospital administration. I have seen poor care of IVAD in general at my facility. Everything from slapping on more readers to loose dressings to unclamped/uncapped lumens to leaving IVAD connected to non infusing IV lines. It's frustrating. My take is administration wants central lines out ASAP so any BSI are not reportable as CLABSI so they don't really care as long as they don't have to report it as hospital acquired and lose money. 

mmc51264 said:

We don't use them hardly at all! Can't give anything extravasating through them, can't draw labs, can't tell if they've infiltrated. BSI or not, they are a bad idea as far as I can tell. Interesting idea though. Are they not considered a central line? 

Does your facility have a policy for using them? My facility allows us to give extravasating medications (like pressors) and we can use them for blood draws. They are not considered central lines and thus do not count for CLABSIs. We use them a lot. I am not a big fan of using them for pressors, but there has been research to support it. 

IV access is generally a pain at my facility. Many newer nurses aren't trained well in placement, and I know that as a floor nurse I worked always in hospitals that had IV therapy teams so I never became very proficient myself. Personally, I don't love them. I wouldn't be comfortable giving a pressor through them, and our policy doesn't allow it. We do use them for blood draws, but they don't draw well for very long. Our infection control team loves them because they're not central lines and there's definitely been a push to use them more in the past year or so. 

seaofclouds21 said:

Does your facility have a policy for using them? My facility allows us to give extravasating medications (like pressors) and we can use them for blood draws. They are not considered central lines and thus do not count for CLABSIs. We use them a lot. I am not a big fan of using them for pressors, but there has been research to support it. 

My facility policy is midlines are OK for pressor use in emergent situations but central line access needs to be started ASAP.  Can't use midlines for blood draws at my facility.

JBMmom said:

IV access is generally a pain at my facility. Many newer nurses aren't trained well in placement, and I know that as a floor nurse I worked always in hospitals that had IV therapy teams so I never became very proficient myself. Personally, I don't love them. I wouldn't be comfortable giving a pressor through them, and our policy doesn't allow it. We do use them for blood draws, but they don't draw well for very long. Our infection control team loves them because they're not central lines and there's definitely been a push to use them more in the past year or so. 

So you've noticed the push for midlines recently as well then.  I know our infection control LOVES them.  IV access is also a pain at my facility as well.  I was an LVN for a long time before becoming an RN and there is definitely a lack of IV proficiency in newer nurses.

Can someone explain me what is midline and why they can not be used for pressors. I have never been trained on them. I would appreciate that. Sometimes I see them in our facility, but rarely. I was told they are like PIV, but longer. My facility does not know how to treat them. Sometimes they are charted as PIV and sometimes as Central Lines.  Sometimes, we are allowed to use them for blood draws and other times we are not.

So a midline is a longer peripheral IV that ensures placement in a vein but does not end in a "central" area (I.e. IVC, RA, SVC). A PICC, right IJ CVL, Temp Dialysis cath all terminate in the RA or just above. A groin CVL tterminates in the large femoral/ illiac veins.  A midline generally terminates in the upper brachial vein (just below the rotator cuff area).

Unfortunately, at my facility, midlines look very similar to a single lumen PICC other that a small round area near the external port. Our policy even uses the same CHG dressings as we do on our PICCs making quick determination of which line is in place. But no pressor use (unless in an emergency till a CVL is established). We have a LDA in our EHR specifically for midline, which helps. Blood draws off a midline are a facility based. Some allow, some don't.  Your educator or CNS should have those answers for you. 

We fight with our IR team, who places our Midlines & PICCs, all the time for placement.  Multiple attempts have to be made via PIV & Ultrasound attempts, trying the legs & feet for a PIV, then it's a doc-to-doc call & maybe you'll get an order but you'll get your line when they have time, sometimes waiting 1-3 days.  By then, they've transferred into my ICU & we place a CVL.

More and more people are coming in with terrible access situations & patient care gets delayed waiting for access.  I do ultrasound IV's on the night shift but only when I or others can leave the ICU. We've had transfers to us because we can't get there due to our own acuity & the patient deteriorated because of lack of access. 

thank you for that