Forum topic

question #1  I have recently started placing powerglides, certainly there are more expert placers that will hopefully speak up here.  I personally feel anything going in a vein should be sterile, most definitely a midline catheter.  As I understand it, some of the reasons for max barrier is to prevent contamination of the wire as it might whip around, and the catheter itself during insertion. With powerglide, those components are neatly contained during the procedure.  In my opinion, head to toe max barrier for powerglide insertion is overkill. 

question #2  That word "continuous" has confused me too.  However, once I saw a vanc infiltration in a midline, the answer to that question is perfectly clear.  In the words of Nancy Reagan "just say no". There may be changes in the future, we will see.

Thanks for the discussion points Gina!

Hello,

We use the BARD Poly non-power-injectable single lumen, 4 FR catheter.  We use the max barrier tray (REF 4154108D).  Our team uses max barrer because we do not want to introduce infection, because we are all also PICC inserters and the max barrier is a habit, because we cover the probe with a sterile probe cover and do not want it to drag across a non-sterile table, and because these are pre-operative surgical patients.  We do not want to take a risk of introducing an infection prior to this surgical procedure (bariatric).  I interpret "unless sterile gloves are worn" as applicable to the midline insertion technique we use and take all precautions.  I am also starting to reach for sterile gloves when using U/S to place a PIV on some of our more difficult access patients.  

Hope this helps.

Carole

Intermittent is confusing. Also, I think the blanket term "vesicant" can be misleading because not all vesicants are administered the same way. In oncology, which frankly is where most poeple think of vesicants, the patient goes to the treatment center, gets IV access of some sort, gets a dose of chemo and the line is pulled or deaccessed. ONS used to say vesicants could go through peripheral IVs as long as they were "virgin" lines. Now they say the nurse should avoid PIVs that are over 24 hours old if possible. ONS is writing its recommendations based on drugs that are infused in a manner similar to Doxorubicin or Vincristine, where a patient gts a single dose and then is good for at least several days. Vancomycin, while still a vesicant, is infused over at least an hour. No "vesicant precautions" used like with other vesicants in oncology. Long winded way of saying that "intermittent" and "vesicant" mean different things based on the drug and how it's given. I think it comes down to thorough patient assessment and avoiding "dumbed-down" decision trees to try to decide what line is best for a patient because of a type of drug. Frankly, if midlines have the same infusion indications as PIVs, then Vancomycin may be given for a short duration until central access can be established because of the high likelihood that the patient will experience chemical phlebitis and related complications if infused repeatedly through a non-central line. I like that fact that ONS has changed the recommendation from "virgin line" to "should avoid a peripheral IV more than 24 hours old" because it emphasizes the importance of a holistic vascular access needs assessment.

We have not used the powerglide.  We are using the Arrow SL 4fr midline.  We use max barrier precautions for midlines nust like the PICCs.  We only insert the midlines for short term use of non-vessicant medications but sometimes the plan changes.  I have a pharmacist that I can co-sign to my notes so that will have extra eyes on the chart looking for medication changes.  I have seen lots of problems with midlines after being infused with vanco.