I agree to 100 % with Michael, nothing to add.
Andre Schotte
Riverside
-----Original Message-----
From: [EMAIL PROTECTED]
To: [EMAIL PROTECTED]; [EMAIL PROTECTED]; [EMAIL PROTECTED]; [EMAIL PROTECTED]; [EMAIL PROTECTED]; [EMAIL PROTECTED]; [EMAIL PROTECTED]
Sent: Mon, 16 Oct 2006 9:53 AM
Subject: RE: Midline guidelines from AVA roundtable
When I place a midline, I always go above the AC using ultrasound, but I measure from my insertion site to just below the axilla with the sterile tape measure provided in my kit. Our midlines usually average 12-16cm in length. So, no, I am not concerned about them going beyond the axilla. 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 Alma Kooistra Sent: Sunday, October 15, 2006 10:32 PM To: [EMAIL PROTECTED]; [EMAIL PROTECTED]; [EMAIL PROTECTED]; [EMAIL PROTECTED]; [EMAIL PROTECTED]; [EMAIL PROTECTED] Subject: Re: Midline guidelines from AVA roundtable 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, Verdana, Arial, Sans-Serif; font-size: 12px; color: #000; background-color: #fff; } .AOLPlainTextBody pre { font-size: 9pt; } .AOLInlineAttachment { margin: 10px; } .AOLAttachmentHeader { font: 11px arial; border: 1px solid #7DA8D4; background: #F9F9F9; } .AOLAttachmentHeader .Title { font: 11px arial; background: #B5DDFA; padding: 3px 3px 3px 3px; } ..AOLAttachmentHeader .FieldLabel { font: 11px arial; color: #000000; padding: 1px 10px 1px 9px; background: #F9F9F9; } ..AOLAttachmentHeader .FieldValue { font: 11px arial; color: #000000; background: #F9F9F9; } .AOLAttachmentHeader a, .AOLImage a { color: #2864B4; text-decoration: none; } ..AOLAttachmentHeader a:hover, .AOLImage a:hover { color: #2864B4; text-decoration: underline; } body { background-color: white; font-family: "Verdana"; font-size: 10pt; border: 0px; } p { margin: 0px; padding: 0px; } img.managedImg { width: 0px; height: 0px; } img.placeholder { width: 275px; 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 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.
