We are being told that D5NS osmolarity is 560mmOsm/liter and being hyperosmolar, needs to be given via a midline. However, there was no references that were provided backing this conclusion up. Does anyone know of any refences or recent studies done indicating that D5NS can only be given thru a midline? D5NS in this instance is being used for IV replacement therapy, there are no other medications in the D5NS. I have been unable to locate anything specific to this scenario indicating a peripheral catheter is inappropriate. This statement was a blanket one, no further criteria (duration of therapy, rate, etc.) was provided. So let's just assume IV replacement therapy on a geriatric pt with no severe co-morbidities (CHF, CRF, ARF, etc) for 1-2 liters at 50-75/hr for 1-3 days. My experience and education indicates that a short peripheral catheter is appropriate in this situation. Am I missing something?
I have no idea who is making these erroneous statements or why! The first point is that the same standards apply for the pH and osmolarity of fluids and medications infused through a short peripehral catheter and a midline - there is no difference because both tip locations remain in peripheral veins. So it this rationale is to apply to midlines, it allso applies to short peripheral catheters and this is simply false. The osmolarity parameter is more than 600 mOsm/L should not be infused through a peripehral or midline catheter. Therefore a solution with osmolarity of 560 mOsm/L definitely CAN be infused thorugh a midline catheter. This is directly taken from the Infusion Nursing Standards of Practice from INS. Your geriatric patient example is a great example of when a midline or peripheral catheter would be appropriate. The choice should be made based on number of peripheral venous access sites, skin integrity, the need for other medications and the possibility that this therapy could be required for a week or several weeks. You are not missing anything. 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
Both a short term peripheral IV catheter and a Midline have their tips ending in the peripheral vasculature, therefore, this solution can infuse safely via both catheters, but I too would prefer a short term peripheral in this case as my organization and perhaps yours has a 96 hr rotate schedule for these IV catheters.
Placement of a mdiline versus a short term peripheral carries many more complications. No need for a midline here, IMO.