Amen. I agree completely.
I have a question though.......we have been using Ultrasound for PICC
placement since April 1. We're doing OK with this (thanks in part to the
good support and encouragement I've received from my benefactors on the
listserve), but when I place a midline I'm reluctant to go above the AC
space due to the tip of the catheter finding itself potentially above the
axilla. We only place midlines for our short-term access patients, and
because of that I've just been inserting them at the AC space. Aren't you
concerned about tip location when you insert midlines higher up the arm?
Alma Kooistra RN, CRNI
----Original Message Follows----
From: "Michael Drafz" <[EMAIL PROTECTED]>
To: [EMAIL PROTECTED], [EMAIL PROTECTED], [EMAIL PROTECTED],
[EMAIL PROTECTED], [EMAIL PROTECTED]
Subject: Re: Midline guidelines from AVA roundtable
Date: Sun, 15 Oct 2006 18:36:49 -0700 (PDT)
We are placing 30-40 Midlines every month. We do assess indications (drugs,
lenght of therapy, diagnosis) very carefully. So if a MD orders a ML and
there is a PRN for Phenergan for example, even if the patient has never
gotten it, we will not place that line. Same with Vanco or other Vesicants.
We have them change the drug(if possible -especially with Phenergan) or they
need to change their order to a PICC.We have very little complications,
especially since we are using ultrasound for Midlines as well and trying not
to use the AC. We do lot's of education with the staff and they usually know
what is appropriate. We follow all our lines for the maintanance care and
can pick up if there are issues.This is certainly not true everywhere and
that should influence what line you utilize in your facility.
But there is a handful patients for whom a Midline is a good option.
Don't we try to do the least invasive line to accomodate the therapy? I
belive that this is another reason why we need to stand up for ourselves as
specialists in Vascular Access. It would be great if most healthcare
providers have the knowledge to assess all the factors about line placement,
but reality is that the number is getting less and less.
I also don't believe in "one fits all" and agree that unless there is
good data proving that Midlines which have been placed for appropriate
therapy and been inserted and cared for by a trained professional have
mostly bad outcome, I don't see why we should deprive some patients of that
option.
Michael Drafz
San Diego
[EMAIL PROTECTED] wrote:
No,
I have not seen the same thing.
--
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: [EMAIL PROTECTED]
> Yes, I have seen the same thing.
> Leigh Ann
>
>
> -----Original Message-----
> From: [EMAIL PROTECTED]
> To: [EMAIL PROTECTED]; [EMAIL PROTECTED]
> Sent: Sat, 14 Oct 2006 10:28 AM
> 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
> 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
>
> ________________________________________________________________________
> Check out the new AOL. Most comprehensive set of free safety and security
> tools, free access to millions of high-quality videos from across the
web, free
> AOL Mail and more.
From: [EMAIL PROTECTED]
To: [EMAIL PROTECTED],
[EMAIL PROTECTED],
[EMAIL PROTECTED]
Subject: Re: Midline guidelines from AVA roundtable
Date: Sat, 14 Oct 2006 17:07:07 +0000
Yes, I have seen the same thing.
Leigh Ann
-----Original Message-----
From: [EMAIL PROTECTED]
To: [EMAIL PROTECTED]; [EMAIL PROTECTED]
Sent: Sat, 14 Oct 2006 10:28 AM
Subject: Re: Midline guidelines from AVA roundtable
.AOLPlainTextBody { margin: 0px; font-family: Tahoma,
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height: 206px; background: #F4F4F4 center center no-repeat;
border: 1px solid #DADAD6 !important; } 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
---------------------------------
Check out the new AOL. Most comprehensive set of free safety and security
tools, free access to millions of high-quality videos from across the web,
free AOL Mail and more.
Michael Drafz RN, OCN, CRNI
Clinical Lead Vascular Access Service
Sharp Memorial Hospital Metropolitan Campus
San Diego, California
