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Discussion

Midlines

Since the INS removed the standard of minimal length (>3 inch) from it's definition of a midline and seemingly focusing more on tip location, how is everyone reconciling PIVs placed in the upper arm? Does anyone's hospital restrict the use of the proximal cephalic vein for access by a PIV?

"Midline catheters are peripheral infusion devices with the tips terminating in either the basilic, cephalic, or brachial vein, distal to the shoulder. The basilic vein is preferred due to vein diameter. The tip does not enter the central vasculature."

Infusion Nurses Society (2011). Infusion Nursing Standards of Practice. Journal of Infusion Nursing. (Jan/Feb 2011, Volume 34, Number 1S, ISSN 1533-1458)

AVA seems to hint that the length of the catheter is still a factor with their VA-BC study guide.

"Peripheral Devices: Midline Catheters: Description: Approximately 20 centimeters in length, terminates in the upper arm at the level of the axilla."

Association for Vascular Access (2011). Study Guide for Vascular Access Certification. Retrieved from http://www.avainfo.org/website/article.asp?id=280516

Any thoughts?

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    Where I work, I think the tip location is what guides the position, with the tip located just below the axilla.I'm not aware that we restrict the use of the cephalic vein. However in the Paed hospital that I work at, PICC lines are the temporary central line of choice, although I have seen midlines used on the CF kids in the community.

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    I believe what they are saying is that for extended dwell catheters this is where they should be placed. PIV can still be placed there but not for extended lengths of time. As for restriction..why would they? Upper arm piv are less prone to severe ranges of motion, causing less torsion on the catheter itself....just my observation...no real data.

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