It would be up to your Risk Management department to make that call--do you currently get consent for Midlline placement? If you do not currently place midlines, then how do you handle lines that do not reach the SVC?
This will also need to be incorporated into your vascular access policies.
It would be up to your facility and legal department
A midline is a peripheral IV by the way so I would let them know that. A midline is not a central line and the tip as Chris points out terminates below the axillary.
With the new INS Standards of 2011 you may also leave a PIV in for up to 29 days. www.ins1.com. I would take this standard with you and the position paper when addressing the consent issue
Kathy, where do your find a statement in the INS SOP stating your 29 day limit? I strongly believe it is not there. So please explain what you are thinking. Lynn
Hi all.... I am a bit confused about the definitions with this catheter, INS Standards and I suppose the FDA criteria for catheters. New products muddle my thinking and probably that of others. These new devices are peripheral catheters but have come out (again) with new uses and conflict with old definitions.
INS Standards seem to define Peripheral catheter as placed in the peripheral vein, tip in the peripheral vein and 3 inches or less (traditionally). The FDA seems to have had a say in clearing for medical use with dwell times for some devices as less than 30 days and more than 30 days if I recall. The Midline that is defined by INS has a tip located not centrally but in the axillary vein (probably distal to the shoulder). I think with a variety of new products that may be seen as "extended dwell peripherals"...they may not necessarily be "Midlines" unless they are longer than 3" AND have a tip in the axillary vein. So why would a written informed consent be necessary for a peripheral device? When the risk is higher than normal?
.... even if INS published a Standard that stated it is their recommendation that site rotation be based upon clinical decision rather than the calendar...did anyone approach their own institutional Medical Executive Committee to discuss and obtain their written perspective and blessing? It is after all a Medical decision to place and remove these devices last time I checked. The MEC and the IC Committee probably do not read INS Standards nor are they concerned about them (should be tho!). If you want to place the 1" PIV or 50-60cm PICC or a 3.1" catheter into a peripheral vein or an 8cm or 10cm catheter into the upper arm with the tip located in the axillary vein it can only be done after evaluating the patient's needs and checking in on the care team's plan for infusions and getting a Medical order to do so. Tip postion should not be the consentable decision, but risk. A 1" PIV (for example) for Amiodarone gtt or 3% Saline gtt IS a high risk!! Shouldn't that be discussed wtih the team and consentable?
It would be up to your Risk Management department to make that call--do you currently get consent for Midlline placement? If you do not currently place midlines, then how do you handle lines that do not reach the SVC?
This will also need to be incorporated into your vascular access policies.
Chris Cavanaugh, RN, BSN, CRNI, VA-BC
It would be up to your facility and legal department
A midline is a peripheral IV by the way so I would let them know that. A midline is not a central line and the tip as Chris points out terminates below the axillary.
With the new INS Standards of 2011 you may also leave a PIV in for up to 29 days. www.ins1.com. I would take this standard with you and the position paper when addressing the consent issue
Kathy Kokotis RN BS MBA
Bard Access Systems
Kathy, where do your find a statement in the INS SOP stating your 29 day limit? I strongly believe it is not there. So please explain what you are thinking. 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
Hi all.... I am a bit confused about the definitions with this catheter, INS Standards and I suppose the FDA criteria for catheters. New products muddle my thinking and probably that of others. These new devices are peripheral catheters but have come out (again) with new uses and conflict with old definitions.
INS Standards seem to define Peripheral catheter as placed in the peripheral vein, tip in the peripheral vein and 3 inches or less (traditionally). The FDA seems to have had a say in clearing for medical use with dwell times for some devices as less than 30 days and more than 30 days if I recall. The Midline that is defined by INS has a tip located not centrally but in the axillary vein (probably distal to the shoulder). I think with a variety of new products that may be seen as "extended dwell peripherals"...they may not necessarily be "Midlines" unless they are longer than 3" AND have a tip in the axillary vein. So why would a written informed consent be necessary for a peripheral device? When the risk is higher than normal?
.... even if INS published a Standard that stated it is their recommendation that site rotation be based upon clinical decision rather than the calendar...did anyone approach their own institutional Medical Executive Committee to discuss and obtain their written perspective and blessing? It is after all a Medical decision to place and remove these devices last time I checked. The MEC and the IC Committee probably do not read INS Standards nor are they concerned about them (should be tho!). If you want to place the 1" PIV or 50-60cm PICC or a 3.1" catheter into a peripheral vein or an 8cm or 10cm catheter into the upper arm with the tip located in the axillary vein it can only be done after evaluating the patient's needs and checking in on the care team's plan for infusions and getting a Medical order to do so. Tip postion should not be the consentable decision, but risk. A 1" PIV (for example) for Amiodarone gtt or 3% Saline gtt IS a high risk!! Shouldn't that be discussed wtih the team and consentable?
Scott Gilbert, RN, VA-BC
Scott Gilbert RN, VA-BC, MPH
Honolulu,