PICC vs. MIDLINE ?

Any info is greatly appreciated! I know the main difference is that the PICC goes to SVC tip where as the MIDLINE only goes to ax. area- but- do you need an xray for a midline confirmation placement?? and/or is the midline "not" considered a central line as the picc is?? It was a quiz question I had and the only other choice- "midlines only take hypertonic solutions and piccs only isotonic" I wasn't quite sure about these - anyone- please explain??

Yes, you still need an CXR. At my facility, we have PICC nurses. They place a PICC, get a CXR. If they can't get the picc to thread to the appropriate place then it's left as a midline. You still need to verify it's placement (make sure it's not in the IJ or anything).

It's not considered a central line.

Also, you cannot run pressors or TPN through a midline.

PICCs and midlines are the same thing just different end position. PICCs end in the heart and midlines end at the auxilla. Do to the fact that midlines should still be atomically considered a peripheral line but cared for as a ceteral line. at our hospital we infuse vesicants and TPN into our PICC lines we in emergency cases also will do PPN into a peripheral line rather than TPN in a central line. We do not currently do midline access. peripherals, or centrals only. We do xray all our central lines for confirmation of placement.

The hypertonic answer is incorrect. Very rarely are hypertonic solutions used. Hypertonic saline can kill someone easily. There are lovely horror stories about lawsuits after hypertonic saline use. I know some hospitals that will only allow certain physicians order it and it can only be given in ICU under very stringent protocols.

I guess it depends on the policy of the PICC team. I recently had a patient who was ordered to have a PICC, but due to recent pacemaker placement ended up with a midline. The PICC nurse said that midlines do not need confirmation with a CXR.

Thats what I thought picc requires xray confiramtion and midline does not- I was told, via computer test, I was wromg. The other choices were

-only a DR can put in PICC line (wrong-so can a trained RN)

-A picc is considered a central line a midline is not (that was wrong as well)

-and picc only gets isotonic solutions and midlines hypertonic (wrong)

I'll see tomorrow if "test" answers were flawed?

Thats what I thought picc requires xray confiramtion and midline does not- I was told, via computer test, I was wromg. The other choices were

-only a DR can put in PICC line (wrong-so can a trained RN)

-A picc is considered a central line a midline is not (that was wrong as well)

-and picc only gets isotonic solutions and midlines hypertonic (wrong)

I'll see tomorrow if "test" answers were flawed?

Depending on the source, a midline is not always considered a central line. The midline ends in the axilla area and is considered a peripheral vein thus it is typically not considered a central line, although it is usually treated like one.

So the correct answers is probably "A PICC is considered a central line and a midline is not."

Although PICC lines and midlines look the same from the outside, they are actually very different. Midlines are considered peripheral lines, whereas PICC lines are central lines. The tip of a PICC line is in the are of the SVC, whereas a midline tip is still in a peripheral vein in the arm.

Any info is greatly appreciated! I know the main difference is that the PICC goes to SVC tip where as the MIDLINE only goes to ax. area- but- do you need an xray for a midline confirmation placement?? and/or is the midline "not" considered a central line as the picc is?? It was a quiz question I had and the only other choice- "midlines only take hypertonic solutions and piccs only isotonic" I wasn't quite sure about these - anyone- please explain??

policy in our hospital is piccs require x-ray, midlines not

picc you can use for all types of procedures ( contrast etc.)

midline just the one with the biggest lumen

also we need an order for the picc

midlines you do not

nici

Any info is greatly appreciated! I know the main difference is that the PICC goes to SVC tip where as the MIDLINE only goes to ax. area- but- do you need an xray for a midline confirmation placement?? and/or is the midline "not" considered a central line as the picc is?? It was a quiz question I had and the only other choice- "midlines only take hypertonic solutions and piccs only isotonic" I wasn't quite sure about these - anyone- please explain??

PICC lines are central lines, the tip is usually in the lower third of the SVC. A midline is a peripheral line, with its tip distal to the shoulder. Since the tip of the midline is not in the central circulation, our hospital does not require a chest x-ray for confirmation of placement.

Hope this helps...