Kathy, Love ya...... Landmark study? You mean the infamous Landmark Catheters? I do not doubt the story of your Mother. I am sorry that she had to have any antibiotics. But I can show you just as many thrombosed veins with PICC's. Placed a PICC line in a Doctor tonight that has had three PICC's and three Clots.
People, people, people, I am not saying everyone should get a Midline.
Seriously, I am just playing the Devil's Advocate. I would love for everyone
to get a PICC if that is what they need. For that matter, a tunnelled
catheter or Port if so needed. I am just saying that a Midline has a place and
that place is dictated on the patient's need. Let's legislate everyone's
practice. No more PICC's placed without Ultrasound Period. Stop teaching the
Introducer technique. Stop teaching Regular floor nurse's how to place PICC
lines. Anyone that places a PICC should be on a Hospital Based PICC team.
Sound funny!!!!!!!! Not if some had their way.
To the List: I love PICC's have to say that..... I am not advocating Midlines
for everyone. And I am pleased to have this forum to communicate with
everyone. I thank Sara and have thanked everyone that has written me from this
forum.
I am just trying to get your attention to the fact that not everyone can place
only PICC's. Please consider this a friendly communication and discussion. I
do not want to turn off anyone. I love you all for everything you give me and
every one on here. Just sometimes we need a person that will argue the other
side.
Love ya's
your friend
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: "Kokotis, Kathy" <[EMAIL PROTECTED]>
> 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
>
>
>
>
>
>
> Confidentiality Notice: This e-mail and any attachments are intended only
> for
> the use of those to whom it is addressed and may contain information that is
> confidential and prohibited from further disclosure under law. If you have
> received this e-mail in error, its review, use, retention and/or distribution
> is
> strictly prohibited. If you are not the intended recipient, please contact
> the
> sender by reply e-mail and destroy all copies of the original message and any
> attachments.[v1.0]
> ________________________________
>
>
> 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
>
> ________________________________
>
> 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
>
--- Begin Message ---I will discourage anyone from running Vancomycin thru a midline periodIt is a vesicantMy mother thrombosed in seven days of Vanco via a midline placed in a physician infusion officeThe 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 laterI ran into a major University Hospital going un-named this week that does vanco via midlines for two weeks of therapyTom 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 ratesKathy
Confidentiality Notice: This e-mail and any attachments are intended only for the use of those to whom it is addressed and may contain information that is confidential and prohibited from further disclosure under law. If you have received this e-mail in error, its review, use, retention and/or distribution is strictly prohibited. If you are not the intended recipient, please contact the sender by reply e-mail and destroy all copies of the original message and any attachments.[v1.0]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 roundtableKelly,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
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 roundtableThis 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
--- End Message ---
