Re: RE: Midline guidelines from AVA roundtable

[VICTORIA SALLESE]

Correct, Vanco is not appropriate for a midline. End of discussion. If only we could get professionals to realize this.

Victoria Sallese
VAT
Johns Hopkins Hospital

----- Original Message -----
From: "Kokotis, Kathy" <[EMAIL PROTECTED]>
Date: Saturday, October 14, 2006 10:14 pm
Subject: RE: Midline guidelines from AVA roundtable
To: Bev and Tim Royer <[EMAIL PROTECTED]>, Kelly Murphy <[EMAIL PROTECTED]>, Chris Cavanaugh <[EMAIL PROTECTED]>, [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
> Vancowas 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
>
> ________________________________
>
> 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
> midlinethat 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
> needed10 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
> homecare 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
> havingthe 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
>