We are trialing a midline product that is leaking from the skin entry site as soon as 24 hours after placement. Placement of this device requires a dermatotomy. Many years ago when PICCs were occasionally trimmed to midline length, we never had this issue (dermatotomy done as well). These are two different manufacturers. Is anyone using a power midline product that does not have this issue? Any thoughts as to why leaking is happening? As a side note, we trim the current product so its tip is well below the axillary region and leaking is still occuring even with a slow flush of NS. The fluid that leaks is clear when flushed with saline, but most of the time it is serosanguineous in nature. Perspiration and damage to catheter are most likely not contributing factors. If a fibrin sheath is the culprit, then why would a PICC trimmed to midline length not leak (when we did this practice years ago), but a true PML does?
Phlebitis from a chemical and/or mechanical cause could be occurring. The midline tip is deep so leaking might be the first clinical sign before redness, etc. What other fluids and meds were being given through this catheter? Size of the catheter in relation to the size of the vein lumen? Fluid volume status of the patient? I know that cutting any catheter can produce jagged edges that increase vein irritation and thrombophlebitis risks, and cutting a PICC to a midline would increase, not decrease this risk. Are you using basilic vein? How is the catheter secured? I think these problems with the new midlines is related to edema in the vein wall from early phlebitis, possible early thrombus development also. 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
Is this catheter you are trying Not tapered?
Were the PICCs you were previosly using tapered?
Which catheter are you using?
feel free to contact me & I can tell you what we are currently using as Midlines.
[email protected]
Timothy McCrory RN, BSN, CCRN, VA-BC
Vascular Access Managment
Columbus Regional Health