RE: Midline guidelines from AVA roundtable

[Chris Cavanaugh]

Kelly, Sorry you have had such troubles.  Perhaps it is due to the type of midline you are using, the patient/homecare nurses techniques, drug itself?  Not really sure.  I have very successfully used midline catheters for hydration and antibiotics with a pH of 5-9 in both homecare and long term care (SNF) settings.  I have used both the Bard PerQ Cath and the BD First Midline.  They typically last as long as needed, 3-4 weeks.  Occasionally, we have used one up to 5-6 weeks, when the MD requests continuation of therapy and the site and the line are working fine.  I only place 3F and 4F midlines.   What size are you using?  The leaking may be due to thrombosis formation beyond the tip or near the tip of the catheter.  Could be other reasons for it also.  Midlines should be placed and treated just like PICC lines as far as care and education for the patient/caregiver.  Perhaps your patients are overusing the arm it was placed in?   Good luck   Chris Cavanaugh, CRNI From: Kelly Murphy [mailto:[EMAIL PROTECTED] Sent: Saturday, October 14, 2006 10:29 AM To: Chris Cavanaugh; [EMAIL PROTECTED] Subject: Re: Midline guidelines from AVA roundtable   This is a little off the original subject, but I have not seen a midline that has lasted the length of treatment yet.  Just yesterday, a patient came to the ED with a midline that was placed 2 weeks ago.  It was leaking at the insertion site.  I spoke with ID and they said he needed 10 more days of IV antibiotics and no, we couldn't change him to PO.  Originally, I was talked into the midline because they weren't sure if he needed 2-3 days or 2-3 weeks, with the promise from both the MD and the PA that if the treatment lasted 2 weeks, the patient would be readmitted.  Being the patient advocate I am, I opted for a midline. Long story short, I ended up putting a PICC in him yesterday in the ED.  This just reconfirms my belief that midlines are relatively useless except maybe in CMO cases.  Almost every midline I've inserted for home care has come back through the ED for replacement.  Does anyone else feel the same way or have the same experience? Not trying to start an argument, just wondering if anyone else is having the same results with midlines as me. ----- Original Message ---- From: Chris Cavanaugh <[EMAIL PROTECTED]> To: [EMAIL PROTECTED] Sent: Saturday, October 14, 2006 6:54:25 AM Subject: Midline guidelines from AVA roundtable For those who could not open the original document posted, here is one as a word document.  Thanks   Chris Cavanaugh, CRNI 3606 Molona Dr. Orlando, FL 32837 407-928-9297