I am a solo PICC insertion/Radiology RN. I am being asked to place midline catheters. So, I have done some research on the definition of the midline. I have reviewed this forum as well as the INS guidelines. I think a midline is a catheter which resides above the antecubital fossa and does not extend beyond the axilla.( I use ULt and MST technique).
This works well for some difficult access patients, especially from med/onc because alot of their patient's veins have damage over time from frequent use.
Now I am being asked to do this procedure for CT scan difficult access patients.
However on page 68 of the 4th edition p and p for Infusion Nursing it states that this type of access should not be utilized for admin of contrast media, irritants, or continous vesicant therapy.
So, what happens when a patient is ordered for a CT scan w IV contrast but we are unable to establish peripheral access?
Thank You
Diane, you raise good questions and there are many experts around here to give feedback. If you put "midline ct" in the search box in the upper right hand corner you will find lots of discussions about this. Hope that helps.
The current INS Standards, Policy and Procedure book and Textbook were all published BEFORE the new type of midline catheters were introduced. There are 3 midlines in this category - Power Glide, PowerWand, and Flexicath. All 3 of these are shorter than older midlines, and all 3 have a labeled indication for power injection. They are also labeled as a midline device. We do not have any clinical studies yet showing outcomes when these are placed as a midline catheter and used for power injection. Most all contrast agents are hyperosmolar with osmolarity greater than 600, although a few are less than this. pH is not the issue with contrast agents. The next standards document is in the early stages of revision but it will not be available until 2016. Until then, you and your facility will need to make your own decision about using these midlines for power injection of contrast. While the new midline catheters are designed to accomodate power injection, the tip location is the question due to the osmolarity of the contrast. The answer for some would be to use these as a form of peripheral catheter. IMHO, this would be outside the standard of practice also which states to choose the smallest gauge and shortest length of catheter capable of delivering the prescribed therapy. A regular short peripheral catheter can do that. In the case of patients with extremely poor veins requiring US, a longer peripheral catheter may be needed. Then the question becomes what is the difference between a 1.75 inch long catheter and a 3.1 inch catheter in a peirpheral vein of the forearm? Again, no studies to demonstrate the outcomes and which is preferred. Your message did not say which type of midline you are comtemplating using for power injection but there are no others labeled with this indication other than the 3 brands listed. 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
Diane,
I would be happy to provide you with further information on the Flexicath M/29 Midterm Catheter - please let me know your thoughts on next steps at any of the points of contact below.
Lynn - thanks for the mention
Best regards,
James (Chip) Hanlon
Chief Operating Officer
Flexicath, Inc.
South Park PA, 15129
412-915-6442 (Cell)
888-614-3448 (Fax)