Re: Midlines

[Leighannbowe]

Chris: I am sympathetic to the challenges that are presented in the LTC setting. Maybe it's time for some political action to try to change things. I am concerned about insertion of a midline when a PICC cannot be completely advanced, regardless of the care setting. What is just past the end of that midline that is causing the obstruction? Is it thrombus? Stenosis? Aberrant pathway? We cannot tell without fluoroscopy or x-ray vision. Are we doing more damage by running a med, even if mildly irritating (and most are at least mildly irritating), so that it makes its way directly to that point of obstruction? I couldn't say, but I am concerned. I worked for a home infusion pharmacy some time ago, and there was a home care nurse who was infusing a cephalosporin via a midline in a home care pt. She called to ask about a problem she was having. She was unable to flush the line each day when she went to see the pt. So, she pulled the midline back, just a little, and was able to administer the drug. The next day, same problem. So, she pulled the midline back, just a little. This went on until there was only about an inch of line in the pt, at which point she called me for advice. The pt had a raging phlebitis, which extended a little further down the arm each day, as the nurse gradually exposed more and more of the vessel to the medication. It works both directions. Leigh Ann