Midlines can be appropriate for some therapies. I was the
clinical educator that wrote the guidelines from the first
manufacturer introduced midlines to the market.
Not all antibiotics are acceptable through a midline and your
message did not state what drug was infusing nor how it was admixed,
the final osmolarity or pH.
Also, Chris's document stated "below axilla" and I
don't think this is sufficient for the description of the tip
location. She also stated that most are inserted for 20 cm. With upper
arm insertion via MST and US, 20 cm will put you in the midclavicular
tip location, not the midline tip location on many patients.
The midline tip location is level with the patient's axilla,
distal to the shoulder. Please note this should not be in the axillary
vein as this vein begins at the lateral edge of the chest. The tip
should remain in either the cephalic or preferrably the basilic vein
and be advanced only as far as required to reach the appopriate tip
location. If you start in the antecubital fossa, some patients may
require 20 cms of catheter length. If you are using upper arm
insertion site, you may only need 10 cm or less. Insertion too much
catheter length will put the tip in the shoulder area and arm movement
will cause mechanical irritation.
I firmly believe that midlines have a place but that they require
a careful assessment of all these factors plus many others.,
Lynn
At 7:28 AM -0700 10/14/06, Kelly Murphy wrote:
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
--
Lynn Hadaway, M.Ed., RNC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
http://www.hadawayassociates.com
office 770-358-7861
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
http://www.hadawayassociates.com
office 770-358-7861
