RE: Midline guidelines from AVA roundtable

[Kokotis, Kathy]

I will discourage anyone from running Vancomycin thru a midline period

It is a vesicant

My mother thrombosed in seven days of Vanco via a midline placed in a physician infusion office

The nurse's answer was to give the vanco every other day to rest the arm.  I stopped that as soon as I got home four days later

I ran into a major University Hospital going un-named this week that does vanco via midlines for two weeks of therapy

 

Tom Lawson who did a wonderful paper back in the old days on infusates via midlines (mid 90's) indicated that the complication rate with Vanco was over 30%.  That is way higher than the complication rate of PICC lines with vanco.  I need to pull out that old paper done on landmark.  It was a great paper on all drugs given via midlines and their complication rates

 

Kathy

 

 

 

 

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From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Bev and Tim Royer
Sent: Saturday, October 14, 2006 9:52 AM
To: 'Kelly Murphy'; 'Chris Cavanaugh'; [EMAIL PROTECTED]
Subject: RE: Midline guidelines from AVA roundtable

Kelly,

 

Our experience has been the same.  Have had some minimal success with midlines in those patients in our long term facilities that needed access for every other day hydration and slow rates (these sometimes last up to 3 weeks).  Everything else usually starts leaking at the site in a week or under, which could mean the vein thrombosed off above the tip.  Also, they stop aspirating after 4-5 days.

 

Chris brings up an interesting point though - catheter size.  For midlines we are using 4fr silicone catheters with the tip terminating just before the axillary vein.

 

Chris,

 

What size midline catheter are you using?

 

Looks like a great subject for research - Midline catheter size and/or material.

 

Timothy Royer, RN, BSN, CRNI

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From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Kelly Murphy
Sent: Saturday, October 14, 2006 7:29 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