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Discussion

Placing midlines on same side as pacemaker

I had a patient the other day who had a mastectomy on her left side and a pacemaker on her right side. So initially I thought she was not a candidate for PICC placement. She needed 4-6 weeks of IV antibiotics, so her doctor sugested placing a midline in the right arm instead since it would not interfere by staying in the axillary vein and not in the SVC. I went ahead and placed the line thinking, there was really no other choice because putting in a groshong tunneled catheter or port would not be possible for the same reasons of the mastectomy and pacemaker. What do you guys think about this? I am having trouble finding any kind of online information related to contraindications for midlines or PICC's. Thanks!

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RN LadyBug..

I would not have any problems placing a Midline on the side with a pacer, but a PICC could be a problem. The older pacemakers will have a decreased risk of lead fracture with its placement though. I don't know of any studies that have been done that show lead fx with insertion, but there is a published study of a percutaneously placed CVC that was being removed and it lead to lead fx because of a thrombus between it and the lead. This however wasn't a PICC. Some will tell you that as long as the wires have had time to become well imbedded, they don't mind placing a PICC. A quess it boils down to your P&P.

Diane

The biggest thing to remember about midlines is that you don't want to give vesicants through it (any drugs with a ph9 or an osmolarity>500). Most antibiotics that are given long term do not meet this criteria. Manufacturer recs say that dwell time should not be more than 4 weeks. I know that midlines are used a lot in nursing homes and home care as they are less expensive, but I would be very cautious about how you use them. Because the tip resides deeper than a peripheral more significant damage can occur before it is detected. With the scenario that was mentioned, as long as the pacemaker had been in for at least 4 weeks and it was ok with the cardiologist, I would have placed a PICC on the side of the pacemaker.

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