Re: Midlines

[ivsetc]

Well, let me ask how many Midlines you have placed?
You seem to have all the knowledge.  Having for worked for how long on a 
Hospital based PICC team with all the advantages that brings gives you an 
absolute knowledge of Midlines and their capabilities and weaknesses?  I think 
that with all the arguements that have gone on this past week and a half on 
this list serve that we could figure out that no one has all the answers.  Not 
even the lofty INS Standards are exceptable to everyone. 

I have placed thousands upon thousands of Midlines in alternative care 
settings.  And never have I had a significant outcome related to Midline 
catheters.  Not one!!!  If everyone had the same advanteages that hospital 
based PICC teams have we would all use PICC's.

I am really tired of the the few that have the advantages making us alternative 
care setting Nurse's look like Nurse's practicing poor care for our Patients.  
Let me see you convince an administrator that placing a PICC and sending the 
patient to the hospital for an X-ray is the only way to give an antibiotic for 
a five day treatment or D5NS because the osmalarity is to high for PIV or 
Midline placement according to INS Standards.  I would love for you to have to 
deal with not only the administrator about the costs involved but with families 
that are private pay.  I routinely cut my charges for private pay to allow a 
patient to get a PICC or Midline so that they can afford to have a line placed 
after a hospital with a PICC team sent the patient back to a nursing facility 
with no line and 4 weeks worth of antibiotics.  If you did not have an x-ray 
department based in your hospital and your President or CFO continually 
received ambulance billsof $500.00 for patients that were sent for x-rays let's 
see how many PICC teams would be based in a hospital setting?  Please answer me 
that one?  Do you think that you would still have a job?  Do not give us the BS 
that you always do based on a Standard.  It is based on a Standard conceived in 
a perfect world scenario like hospital based PICC teams.  Still feel uppity?  
Ask your CFO if you would still be placing PICC lines or would your Hospital 
CFO make you use Midlines even though the Standards say you should use a PICC!  
And please do not give me the BS that you would rather quit than place 
Midlines!  Please, that is BS!!!  Cost of services rule in healthcare!  Cost is 
what every business is dealing with.  If you cost more than IR you would not 
have a job. Period.

If you still believe what you are advocating,  I can give you the number of 
hundreds of Administrators, Medical Directors and Directors of Nursing.  You 
can explain to them the need for PICC placement and X-rays vs. Midlines.  I 
know the Standards!!  I folow them to the best of my ability.  I paid the money 
for three Ultrasound machines to advance my practice.  I give my all to my 
patients, clients and customers!!!!  I take the Standards for what they are 
Standards.  If I ever have to defend myself in a Court of Law I will do my 
best.  But then again after having been in Infusion Therapy and Vascular Access 
for 16 years I have never had to do that.  Even after having placed 10-12000 
Midlines over those same years.

OK, I am sorry for those of you that do not want to see this kind of e-mail on 
the list serve.  I myself am tired of the bickering.  So this will be my last 
e-mail.  I tried once to get off the list serve due to angry e-mails but was 
unsuccessful.  So this is it.  Many years on the list serve, many years gaining 
some valuable knowledge from the members.  But, I see an elitetist attitude 
that I am not comfortable with anymore.  I have seen it for many years, but I 
felt that I got something from the issues.  No more.

To: Kathy Kokotis,  Kathy always loved your enthusiam for Vascular Access 
mostly agreed with you on everything.  Bought my first Ultrasound based on your 
valued leadership.  And you were there when I learned to place my first PICC. 

Lynn Hadaway:  Do not always agree with you. LOL  But respect your positions.  
I have learned much from your emails even if I did not agree with them.

To all those Nurses that work in alternative care settings:  Continue to 
provide the best services for your patients regardless of what everyone with 
rose colored glasses say.  You are the front line and the last line for these 
patients.  You are the nurses that deal with all issues in vascular access.  
You need to keep on fighting for the best in vascular access for your patients. 
 Fighting the CFO's and administrators to get to where the Standards are.  
Maybe in the future we will not need debates on PICCs vs. Midlines or 
Ultrasound vs. non-ultrasound placement.  I am not sure that day will ever come 
but if it does I will be happy.  I am very sorry to have gone on for so long.  
I do not normally vent my frustrations in a public setting.  But please do me a 
favor, do not make us lowly alternative care nurse's feel like we are the 
wicked step children.  I am sure that there are more experienced PICC nurses 
placing lines in alternative care settings than nurses placing lines on 
hospital based nursing teams.  Maybe not.
PS:  Heather and Leigh Ann:  This is not directed solely to you two.  It just 
happened that Heather's e-mail is the one in which I replied. I know you two 
and like you!!!!  Sorry

Please Unsubscribe!!!

--
Randy Ross R.N., B.S.N.
IV Nurse Consultant,
President & C.E.O.
IV's Etc...  LLC
Vascular Access
    & Consulting
Ph: 317-541-6463
Fax: 317-894-7709
Email: [EMAIL PROTECTED]
Website: www.IVsEtc.com

 -------------- Original message ----------------------
From: "Heather Nichols" <[EMAIL PROTECTED]>
> Ditto.  Well said!  Kudos!
>  
> Heather Nichols RN BSN CRNI 
> Infusion Services
> University of Louisville Trauma Institute
> 530 S. Jackson St.
> Lou. Ky. 40202
> (502)562-3530
> 
> >>> "Leigh Ann Bowe-geddes" <[EMAIL PROTECTED]> 02/04/06 8:39 AM >>>
> 
> While it does occasionally happen that a fibrin sheath completely
> covers a line and causes retrograde flow of the solution, I have seen
> chemical phlebitis be a more common cause of retrograde flow when the
> line is a midline. There are very few medications that can safely be
> administered via midline without causing phlebitis. The inflammation can
> cause the path of least resistance (or the only available path) to be
> retrograde. Make sure that you are choosing wisely when placing a
> midline. Like you, Nancy, we have essentially stopped placing midlines.
> It is too rare in our circumstances that the infusate is appropriate. 
> Another important point may be to stop placing dual lumen midlines. The
> blood flow at the point of tip termination is not adequate to properly
> dilute two different medications, particularly if these meds are not
> compatible with one another. 
> Leigh Ann
>  
> Leigh Ann Bowe-Geddes, RN, CRNI
> IV Therapy Specialist
> Infusion Services Department
> University of Louisville Hospital
> Louisville, KY
> 502-562-3530
> 
> >>> <[EMAIL PROTECTED]> 02/03/06 9:36 PM >>>
> 
> Nancy,
> It happens occasionally to me also.  But, it can also happen with PICC
> lines.
> The catheter is has developed a fibrin sheath.  The sheath completely
> covers the catheter.  The fluid runs through the catheter and into the
> sheath and with no where to go it comes back down the cathter.  At least
> this is my deduction from many years of experiencing this phenomenon.  I
> use to think it was me or my technique, then maybe the catheter.  But, I
> have found that it can happen to any nurse and any brand of cathter. 
> With PICCs and Midlines.
> 
> A study would be great but, I could not perform the study due to lack
> of resources.  My lines are placed mainly in the external settings and
> can not afford to send the resident to IR for a Dye study.  But, I
> believe that this is what is occuring with your catheters as well.  I
> now use the Groshong 4Fr single PICC but, previously used the V-Cath as
> well and both cathteters can have this happen.  I can tell you that when
> you take the line out nothing will be on the catheter.  And after
> inserting another catheter some patients will continue to develope these
> sheaths.  Some do not.  Without a study of the patients labs,
> medications, and previos history I am afraid an answer is not
> forthcoming as to what patient will or will not develop these sheaths. 
> 
> 
> I have ask many experts and catheter reps and no one seems to have the
> answers.  Actually most think it is the fault of the inserting nurse and
> their technique.  I believe it is with the patient and their
> physiology.
> 
> Just my two cents.
> Randy
> 
> --
> Randy Ross R.N., B.S.N.
> IV Nurse Consultant,
> President & C.E.O.
> IV's Etc...  LLC
> Vascular Access
>     & Consulting
> Ph: 317-541-6463
> Fax: 317-894-7709
> Email: [EMAIL PROTECTED]
> Website: www.IVsEtc.com
> 
> -------------- Original message ----------------------
> From: "Nancy Sullivan" <[EMAIL PROTECTED]>
> > Here goes some question about Midline.
> >   My hospital IV team (that I am on) has stopped putting in midlines
> because we 
> > were experiencing leaking at the insertion site. 
> >   Is any one else experiencing this problem.
> >   Also, Do you place them in the ac or upper arm?
> >    Do you use MST and or ultrasound to place a midline?
> >   Where is the tip if you use the upper arm?
> >   We use Bard 4fr groshong ad 5fr dual per q cath midlines, that is
> if we happen 
> > to put one in.
> >   Thanks
> >   Nancy
> >    
> > 
> >         
> > ---------------------------------
> > Brings words and photos together (easily) with
> >  PhotoMail  - it's free and works with Yahoo! Mail.
> 
> 
> 
> 
> 
> 
> 
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> recipient(s), please notify the sender or contact the University of
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> 
> 
> -----------------------------------------------------
> Confidentiality Disclaimer
> 
> This message, including any attachments, is confidential and intended
> only for the named recipient(s) and may contain information that is
> privileged or exempt from disclosure under applicable law, including
> PHI (Protected Health Information) covered under the Health Insurance
> Portability and Accountability Act (HIPAA) of 1996.  If you are not
> the intended recipient(s), you are notified that the dissemination, 
> distribution, or copying of this message is strictly prohibited.  
> If you receive this message in error, or are not the named recipient(s), 
> please notify the sender or contact the University of Louisville Health 
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--- Begin Message ---

Ditto.  Well said!  Kudos!   Heather Nichols RN BSN CRNI Infusion Services University of Louisville Trauma Institute 530 S. Jackson St. Lou. Ky. 40202 (502)562-3530 >>> "Leigh Ann Bowe-geddes" <[EMAIL PROTECTED]> 02/04/06 8:39 AM >>> While it does occasionally happen that a fibrin sheath completely covers a line and causes retrograde flow of the solution, I have seen chemical phlebitis be a more common cause of retrograde flow when the line is a midline. There are very few medications that can safely be administered via midline without causing phlebitis. The inflammation can cause the path of least resistance (or the only available path) to be retrograde. Make sure that you are choosing wisely when placing a midline. Like you, Nancy, we have essentially stopped placing midlines. It is too rare in our circumstances that the infusate is appropriate. Another important point may be to stop placing dual lumen midlines. The blood flow at the point of tip termination is not adequate to properly dilute two different medications, particularly if these meds are not compatible with one another. Leigh Ann   Leigh Ann Bowe-Geddes, RN, CRNI IV Therapy Specialist Infusion Services Department University of Louisville Hospital Louisville, KY 502-562-3530 >>> <[EMAIL PROTECTED]> 02/03/06 9:36 PM >>> Nancy, It happens occasionally to me also.  But, it can also happen with PICC lines. The catheter is has developed a fibrin sheath.  The sheath completely covers the catheter.  The fluid runs through the catheter and into the sheath and with no where to go it comes back down the cathter.  At least this is my deduction from many years of experiencing this phenomenon.  I use to think it was me or my technique, then maybe the catheter.  But, I have found that it can happen to any nurse and any brand of cathter.  With PICCs and Midlines. A study would be great but, I could not perform the study due to lack of resources.  My lines are placed mainly in the external settings and can not afford to send the resident to IR for a Dye study.  But, I believe that this is what is occuring with your catheters as well.  I now use the Groshong 4Fr single PICC but, previously used the V-Cath as well and both cathteters can have this happen.  I can tell you that when you take the line out nothing will be on the catheter.  And after inserting another catheter some patients will continue to develope these sheaths.  Some do not.  Without a study of the patients labs, medications, and previos history I am afraid an answer is not forthcoming as to what patient will or will not develop these sheaths.  I have ask many experts and catheter reps and no one seems to have the answers.  Actually most think it is the fault of the inserting nurse and their technique.  I believe it is with the patient and their physiology. Just my two cents. Randy -- Randy Ross R.N., B.S.N. IV Nurse Consultant, President & C.E.O. IV's Etc...  LLC Vascular Access     & Consulting Ph: 317-541-6463 Fax: 317-894-7709 Email: [EMAIL PROTECTED] Website: www.IVsEtc.com -------------- Original message ---------------------- From: "Nancy Sullivan" <[EMAIL PROTECTED]> > Here goes some question about Midline. >   My hospital IV team (that I am on) has stopped putting in midlines because we > were experiencing leaking at the insertion site. >   Is any one else experiencing this problem. >   Also, Do you place them in the ac or upper arm? >    Do you use MST and or ultrasound to place a midline? >   Where is the tip if you use the upper arm? >   We use Bard 4fr groshong ad 5fr dual per q cath midlines, that is if we happen > to put one in. >   Thanks >   Nancy >    > >         > --------------------------------- > Brings words and photos together (easily) with >  PhotoMail  - it's free and works with Yahoo! Mail. ----------------------------------------------------- Confidentiality Disclaimer This message, including any attachments, is confidential, intended only for the named recipient(s) and may contain information that is privileged or exempt from disclosure under applicable law, including PHI (Protected Health Information) covered under the Health Insurance Portability and Accountability Act (HIPAA) of 1996.  If you are not the intended recipient(s), you are notified that the dissemination, distribution, or copying of this message is strictly prohibited.  If you receive this message in error, or are not the named recipient(s), please notify the sender or contact the University of Louisville Health Care I.S. helpdesk at 502.562.3637 to report an inadvertently received message. ----------------------------------------------------- ----------------------------------------------------- Confidentiality Disclaimer This message, including any attachments, is confidential, intended only for the named recipient(s) and may contain information that is privileged or exempt from disclosure under applicable law, including PHI (Protected Health Information) covered under the Health Insurance Portability and Accountability Act (HIPAA) of 1996.  If you are not the intended recipient(s), you are notified that the dissemination, distribution, or copying of this message is strictly prohibited.  If you receive this message in error, or are not the named recipient(s), please notify the sender or contact the University of Louisville Health Care I.S. helpdesk at 502.562.3637 to report an inadvertently received message. -----------------------------------------------------

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