Midline venous catheters

[cannulation]

Hello

I am a nurse educator from England, at the present I am writing a policy for midline catheters. There use here is not that common as yet, one post insertion complication I have noted is bleeding from the insertion site. Can anyone adivse how to manage this and has anyone got any references re this I can use.

Thanks

[UM Review RN, ASN, RN]

Might this help?

http://www.ins1.org/publications/other_pub/policies_procedures.html

[cannulation]

Thanks Angie

[nurse_drumm]

our facility places a 4x4 gauze over the site (but not completely covering it to keep the insertion site visible), then dresses it according to procedure.... the initial dressing stays for 24 hours, and then it's removed and redressed without the gauze with a new dressing. seems to work well for us, we do them frequently.

[cannulation]

Thanks for that Nurse Drumm, I have read a couple of articles that recomend the guaze.

[sbivrn]

That's interesting. Do you place midlines in the same manner as PICC lines? We use the modified seldinger technique for both and don't have anymore problems with bleeding from one to the other. It usually depends on the bleeding times and whether or not the patient has been on a thinner. If we have bleeding after insertion for either we do a gauze dressing for 24 hours.

[cannulation]

The use of midlines within our hospital is improving but needs to be improved on, yes sbivrn the same method is used. I have not had experience of putting in midlines myself yet, I need to be trained, but I am writing a policy on midlines, so checking best practice. I have one more question sbivrn, do you routinely withdraw blood from your midlines to confirm placement as done with central lines, I would say not due to small lumen creates more complications, I would use other observations to ensure tip placement, but I would value your experience.

[sbivrn]

Yes we do use blood return as an indicator of satisfactory placement. We do not xray midlines. We typically use (on the adult patient) 4 french single lumen catheters for midlines, cut to have the tip locate in the axillae. We will flush afterwards with 20ml of NS and use the CLC 2000 positive pressure device on the end to help maintain patency.

[cannulation]

Thanks sbivrn, very useful information do you know of any articles that define what you have told me about blood draw from midlines.

[sbivrn]

I don't believe you'll find any articles on blood draws from midlines. I am not aware of any. We do not do blood draws. Maybe I was unclear. We check for a blood return upon insertion. Then flush really well with NS.

[cannulation]

Thanks sbivrn sorry misread your last message, all clear now

[sbivrn]

Lots of luck to you. Love to hear about anyone making new strides in vascualr access for their institutions. You're doing a good thing!