Alma I take this as a compliment as does Richard Anderson of Evangelical Hospital in Lewisberg Penn. You will see touches of Kokotis in the midline paper as I helped Richard write his first paper. The paper is published in JIN in 2005 I believe. The paper follows midline outcomes for key LOS and diagnoses in the hospital setting. These are short term therapies and vesicants are not used via midlines as the hospital puts in PICC lines with ultrasound. This are a small rural community hospital and evaluate each patient regularly as to outcomes and drug changes. The hospital is only 130-150 beds and uses about 1,500 PICC and midlines a year. Shocked? They have one of the best early assessment programs in the country where they do use both types of VAD's. But as I said they monitor the usage in the appropriate patients and monitor outcomes on all VAD's. They have early assessment triage with built in parameters like the Braden scale. Rick heard me speak in 1996 on Early Assessment and took me to heart and implemented the process. He is awesome. He moved into micro, portable ultrasound with his three part time RN's and his full time position. He is a working supervisor. I have a high respect for his midline usage as he is using midlines in patients that normally would get peripherals only. He is using midlines for hip replacement over a certain age group. Pneumonia over a certain age group etc. He updates his triage protocol yearly. His midline usage is for the patient population with short term therapies that are non vesicant but have underlying medical conditions such as prednisone, CHF, diabetes etc
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] -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Alma Kooistra Sent: Tuesday, October 17, 2006 7:13 PM To: [EMAIL PROTECTED]; [EMAIL PROTECTED] Subject: Re: Midline guidelines from AVA roundtable There was an outstanding article in the JIN around a year or so ago (somebody, help me out) that was done re use of midlines. It was very good, and I used it for education. Of course now it's late at night and I don't know what I did with it. Please someone, reference it so these people can benefit. FYI......we do use midlines, but still only a very small percentage of the lines we place. We're pretty good at doing an early assessment of patient's venous access needs, and when that assessment is done soon after the patient hits the hospital a midline can become a less viable option because diagnostics may still need to be done. I really hesitate to put a midline in a patient on whom we don't have a firm diagnosis and plan of care. Alma Kooistra RN, CRNI ----Original Message Follows---- From: "Gwen Irwin" <[EMAIL PROTECTED]> To: [EMAIL PROTECTED] Subject: Re: Midline guidelines from AVA roundtable Date: Tue, 17 Oct 2006 19:50:35 -0500 Randy, I hear you about midlines being a viable choice for venous access. I too believe that midlines have a place in our assessment of the patient that needs venous access. I have a midline study approved by our IRB, but am unable to do the study, due to staffing and the manpower to complete it. I have tried for 3 years to complete it without success. Currently, we are not doing midlines. That doesn't change my mind that they are a viable option. I have to challenge you to provide all of us that don't use midlines to SHOW US THE DATA! If you have thousands without complications, please share the data. Please publish your outcomes. Don't defend their use, prove that they are an option! Outcomes that you are supporting would be the change factor of current INS standards about midlines. I would love to see this information! Gwen Irwin Austin, Texas ----- Original Message ----- From: <[EMAIL PROTECTED]> To: "Alma Kooistra" <[EMAIL PROTECTED]>; <[EMAIL PROTECTED]>; <[EMAIL PROTECTED]>; <[EMAIL PROTECTED]>; <[EMAIL PROTECTED]> Sent: Saturday, October 14, 2006 6:32 PM Subject: Re: Midline guidelines from AVA roundtable >BS and Poppycock........................... >Tired of you people that continually make those that use Midlines feel that >they are bad practitioners. > >OK, Put your money where your mouths are........ Show us how many >Midlines you have placed.... How many you have had that have had >complications.... and then show us your PICC Stats as well. Show us. I >have seen thousands of Midlines go a month without complication. Give me a >reason to cross over!!! >Give me a reason to stop defending their use!!!!! And give me your >proof..... >Not some article based on Bias. An article not written by someone >associated with a particular Company such as Navigator or Sherlock that >wants every line placed to be a PICC so that they hawk their wares. Show >me!!!!!!! > >Show me your Data!!!!! And I will stop arguing for Midlines. I know the >Standards so please don't send me those. > >You everloving Lightning rod. >Randy > >PS. Alma sorry that it was your email responded too. No offense to you. > >-- >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: "Alma Kooistra" <[EMAIL PROTECTED]> >>We generally refrain from placing a midline in anyone who has a potential >>of >> >1 week of IV therapy, no matter how benign the infusate. Personally, I >>think that anyone sick enough to need access >1 week probably should have >>a >>PICC. That's pretty 'out there' I know, and that philosophy is not >>written >>in policy at my facility. I just think it makes good sense, and since I >>insert nearly all of the lines it's pretty easy to enforce. >> >>Alma Kooistra RN, CRNI >> >> >> >> >>----Original Message Follows---- >>From: [EMAIL PROTECTED] >>To: [EMAIL PROTECTED], [EMAIL PROTECTED], [EMAIL PROTECTED] >>Subject: Re: Midline guidelines from AVA roundtable >>Date: Sat, 14 Oct 2006 12:31:44 -0400 >> >>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 <[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. >> >> >> > > >
