A friend recently was a patient in a local hospital and had a power glide inserted. The friend is very familiar with the insertion procedure from hearing my experience placing PICC's and Midlines for 20 years. I have always stressed the importance of using the best sterile technique when inserting lines. I presently, and have for years used max barriers for any Midline insertion. I was told that this facility does not use max barriers when inserting the Power Glide midline. I explained that with any extended dwell catheter they must use max barrier drapes. I have found no literature stating that max barriers should be used and found nothing in the INS standards about max barriers. The Power Glide kits comes with a fenestrated drape in the full kit but doesn't mention max barrier drape. I feel that it is best practice to use a max barrier drape for any extended dwell catheter with a dwell time of 29 days. My friend also said that the hospital does not give any local anesthesia to insert the catheter. I would think that insertion into the upper arm of Basilic, Brachial, or cephalic vein should require the use of a local anesthetic agent be used. It is barbaric to think that this would be done without any local. I would not place a line in this area without it. What are your thoughts on these two issues?
Warren Willard, CRNI, VA-BC
Forum topic
Tue, 12/03/2013 - 19:52
#1
Powerglide midline catheter
All studies about the need for full body draping have been done with PICCs, etc. There are no studies showing the need for full body drapes with insertion of a midline. Without evidence, it comes down to professional opinion. Standards and guidelines require evidence beyond opinion. Some would argue that the design of these new catheters do not require full drapes, but we simply do not have any studies about this issue at all.
Also, the 29 days is a misleading marketing ploy. There is no optimal dwell time known for any VAD including midlines. For more information about this issue, I would refer you to my online course on Midline Catheters on our website, www.hadawayassociates.com.
As for the local anesthetics, this seems totally reasonable to use them, although the needle for these newer designs is smaller than the old methods. Again, a lack of evidence prevails. 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
Thank you for your response. I realize that CDC has no guideline for dwell time for midline catheters but, its seems only reasonable to me that any VAD that remains in a patient longer than 96 hrs should be inserted with greater care due to increased risk of infection the long a line remains in place. As for local anesthetic for insertion, I know that the needle itself is not like using an MST insertion, but due to the area of venipuncture, that area is very tender and with the technology and Vascular Access Teams inserting these, there is no reason to hurt patients like that. I practice with the mind set that I am placing the line on a loved one and don't want to hurt them. I also feel the same about using the most sterile procedure during insertion due to the blood stream infection possibility. I know that the rate of midline infection is lower than PICC rates, but I do see infected midlines. I believe that it is due to poor maintenance of the line. It usually occurs beyond the 10 to 14 day dwell time. Nurses like to keep 2x2's under tegaderms, leave old stat locks on and leave old biopatches on. I also notice that the caps are never changed. When mentioned to them about the caps, they always tell me that they didn't know that they should be changed. The education in nursing homes is never ending, no matter how many times you cover the same topic.
I did take your online midline class a few months ago.
Thank you, Warren Willard
I agree that this area requires some local anesthetic with any type of PIV or Midline catheter. Even with local, it is not painless. Most policies I have read neatly sidestep this issue. In some settings, the need for local anesthetic would limit who can perform this procedure. I don't advocate doing it without it.
Genine Schwinge, ANP-BC, PNP
Vascular Access Coordinator
J T Mather Memorial Hospital
Port jefferson, NY 11777