Thanks, Kathleen. You're right about not placing Midlines inappropriately just to do a study! I think I was a little too irate when I posted! I plan to do as you suggest with color photos of extravasations of dopamine and vancomycin. I also plan to do some additional education of the ICU nurses, as he is wanting them to train to place the Midlines since I.V. Therapy team won't place them. I also plan to list for him the indications and proper use of a Midline, when we will be happy to place them. Thanks again. Tanya
-----Original Message----- From: Witt, Kathleen [mailto:[EMAIL PROTECTED] Sent: Friday, September 29, 2006 2:30 PM To: Nauman, Tanya; [EMAIL PROTECTED] Subject: RE: Midlines-use in your practice We place about 25 Midlines a month as compared to 120 PICCs, but we rarely place them in an ICU pt and NEVER for the drugs you listed. The rare ICU pt may be one that is moving out to the floor that is still on IVFs/pain meds or just needs access otherwise we always place a double or sometimes a triple lumen PICC in all of our ICU pts. Our typical Midline pts are those like post op joint replacements that may need a transfusion and then access for a few days, Sickle Cell needing hydration/PCA, pre/post ICD/Pacemakers, and anyone that just needs access, IVFs, non-vesicant drugs for short term. Our biggest use is for our headache therapy population (they are in-house for 5 days on continuous therapy). We place about half of our midlines in these pts (I got a Midline about a month ago for this and it was GREAT!!!!). I would not place a Midline on a pt who needed vesicant drugs just to do a study and just because that is what the doctor wants. You can cause too much damage to the pt. I would tell him you would be able to place a PICC for him, but if he wants a Midline then he can place it. Let him take the responsibility of causing the damage. Why don't you show him the difference in the drug ph/osmolarities and why you don't want to put certain ones through a Midline. Maybe add some pictures of tissue damage to make a point! Kathleen Witt RN, BSN Nutrition Support Presbyterian Hospital of Dallas 214-345-7468 [EMAIL PROTECTED] -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Nauman, Tanya Sent: Friday, September 29, 2006 2:11 PM To: [EMAIL PROTECTED] Subject: Midlines-use in your practice I know this had been discussed previously, but I get an error message today when I try to access "archives". Do any of you routinely place midlines? What are your criteria for placing them? Do you know of any published research supporting (or not) their use in certain situations? Much of the research I've seen had to do with the Landmark catheters. The medical director of our ICU's wants the ICU RN's to learn to place these because we give him such a hard time when he orders them. I think he would have them placed in nearly every patient. He sees no problem with running Dopamine, Vanco, etc. through them...that's why we strongly encourage PICC's and discourage Midlines...but he's sick of us and plans to circumvent us...you can tell I'm upset about this. A couple of years ago I quoted a study (I don't remember which one now), and it was a study done by nursing---he wants Physician studies! I've thought about offering to personally do a study, placing so many Midlines and keeping stats on infusates, medications, outcomes, number of days in place, etc. But, I don't know if this is worth my time, as I think it may just be a power struggle issue and he doesn't want anyone arguing with his orders. Thanks in advance for any input. Tanya ___________________________________________________________ This message is intended solely for the use of the individual and entity to whom it is addressed, and may contain information that is privileged, confidential, and exempt from disclosure under applicable state and federal laws. If you are not the addressee, or are not authorized to receive for the intended addressee, you are hereby notified that you may not use, copy, distribute, or disclose to anyone this message or the information contained herein. If you have received this message in error, immediately advise the sender by reply email and destroy this message. The information contained in this message and any attachments is intended only for the use of the individual or entity to which it is addressed, and may contain information that is PRIVILEGED, CONFIDENTIAL, and exempt from disclosure under applicable law. If you are not the intended recipient, you are prohibited from copying, distributing, or using the information. Please contact the sender immediately by return e-mail and delete the original message from your system.
