Since a midline catheter is a peripheral line, is a special physician's order needed to insert a midline catheter or is the order for a peripheral IV sufficient? Also since a midline catheter is considered a peripheral catheter, is written consent needed to insert a midline catheter?
Thank you
Denise;
We look at several factors. Is the therapy expected to last 7 days or more? (see INS policy and procedure 32., Midline catheters) ....... if the therapy is 7 days or over we do not get a separate order. If the solution to be infused is appropriate for a peripheral catheter ........ we do not get a separate order. If a patient does not have vasculature suitable for a hand or forearm peripheral catheter placement and a midline placed via ultrasound proximal to the antecubital fossa is the only access ....... we do not get a separate order. If a midline needs to be re-inserted (and there are less than 7 days of therapy left) or if the ordered therapy is for less than 7 days ...... we ask for an order. If a midline is requested but the patient and their therapy do not meet the INS guidelines ....... we ask for an order.
We see patients in many different facilities .... the consent issue is different in each. The range of consent is: some require absolutely no consent at all ......... all the way to some facilities use the same consent (we just check the midline box instead of the PICC box) as we use for PICC lines with witnesses etc. I think ultimately the issue and format of consent would be best derived from collaboration between your risk management, nursing and administration.
Lynda
The answers to your questions must come from your risk management dept after consideration of all the rules and regulations from you state board of nursing if there are any that would apply. There are many different ways to approach both of these questions for the use of a midline. Some would say that it does not require a specific prescription from the licensed indedpent practitioner (I refuse to use the word "order" anymore as it seems demeaning to what nursing does. Also LIP's with prescriptive authority now extend well beyond MD only) because it is remains in a peripheral vein. This same logic may also be applied to the need for a signed piece of paper called the informed consent. Actually informed consent is the entire process of education ending with this signed piece of paper and not just the paper itself. 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