I am wanting to get some feedback on PICC/midline use. We are a 240 bed faciltiy and place 50-75 PICCs/month and 0 midlines. What size is your facility--how many beds? How many PICCs and how many midlines per month do you place. What meds/fluids are you giving thru the midlines? We are looking at the possibility of using these lines again--we haven't placed any for the past 5+ years and thought this might be a viable alternative to placing a PICC at times and more cost effective as well as reduce the risk for CL infections. Anxious to hear any input! Thank you!
There is now a new midline - PowerWand by Access Scientific - with labled indication for power injection. I have used midlines in the past for COPD for aminophylline drips plus ABX and steroids and for DVT's with heparin drips. Also urosepsis for fluids and ABX. For any ABX, the key to midline infusion is the drug's pH and osmolarity. Final pH is determined by the drug manufacturer. Final osmolarity is determined by how your pharmacy compounds the drug. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
What a great forum this is to share ideas and perspectives!! I believe the right answer to this situation lies within the experience you already have from placing PICCs at your facility. What behaviors have you seen with the nurses that use your PICCs? Are tubings dated?, secondary lines left uncapped?, PIV's well maintained?, CVC's left in with dressings half off?, IV's running that are infiltrated?. The issue with midlines in my experience is not the midline, or the person who has inserted it, but the nurses and physicians who simply do not understand the importance of using the appropriate drugs for these lines. I have seen far too many vanco/acyclovir/TPN/PPN disasters to assume that a well thought out, well placed midline will be used in a well thought out way. Your hospital/vascular access team may or may not have done an outstanding job teaching the appropriate use of midlines and IV access in general. It would be a very valuable exercise to do an honest assessment of where the facility is now with vascular access behaviors, and then decide to proceed or not depending on what you find.
Stephen Harris RN, CRNI, VA-BC
Chief Clinical Officer
Carolina Vascular Wellness
We place a midline when we can't get the PICC to the low SVC. This occurs for many many reasons. In general we do not like them because we feel they don't last and are so prone to dvt development. We place our midlines using the same technique as a PICC, just shorter, never past the axilla. I am not sure the risk for CL infections would be any less or more. It just won't show up in the numbers but the infections and subsequent associated costs (length of stay, complications) would be seem to be the same.
Martha
We use midlines only if we cannot get the PICC to lower SVC. They work as a short term fix for a pt with poor venous access or if they just need access for a CT, etc. We instruct the nurses not to use them for lab draws due to the high risk of clotting/thrombus or for medications that require central access.
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