Midline Catheter Placement generally starts in a vein in the arm just above the elbow and remains in the peripheral vein; it does not end in a central vein or near the heart. Midline Catheter Placement is generally inserted by PICC Nurses, who are trained in Ultrasound Guided PIVs, Midlines, and PICCs placements. Midline Catheter Placement is usually performed using an Ultrasound as a reliable way to view and guide the needle. The Modified Seldinger Technique (MST) is mostly used for correct placement and some PICC Nurses use needle guides and others use the preferred needle visualization, as this can lead to obtaining vascular access in difficult access cases. As the catheter does not end near the heart, there is no need to confirm placement using an ECG or X-ray.
What is a Midline Catheter Used For
| PICC Line Midline Catheter
The Midline Catheter is used for vascular access treatments in patients that require IV access where non-caustic medication is administered. Midlines are versatile and effective vascular access devices when Peripheral IVs and Extended Dwell PIVs are not clinically indicated, there is diminished lower arm Access Insertion Sites, or poor peripheral venous volume. Midline Catheters are available in single and double lumens (ie, tubing and cap) enabling them to be used for delivering multiple medications separately. Not all PICC Services companies offer double lumen Midline Catheters.
A PICC Line Midline Catheter is not a line but rather usually denotes a phrase when someone is looking to evaluate the difference between the Midline and the PICC Line. PICC Lines can be overprescribed as a default when Midline Catheter Use is a better choice given all the clinical factors. With the proper training on Midlines, PICC teams or nurses and even advanced vascular access clinicians can take full advantage of the Midline Catheter to place after thoroughly evaluating the patient including the patient’s medical history.
Difference Between Midline and PICC Line
The primary difference between the Midline and PICC line catheter is that the Midline is inserted in a peripheral vein and ends near the upper arm as it is not a central line, while the PICC line is a central line that is generally inserted in a peripheral vein above the elbow and weaves around the shoulder to inside the SVC, a vein just above the heart. The SVC is a large vein that enables caustic medications to be received and diluted prior to being dispersed into the bloodstream via the heart for prompt access. This placement brings unique benefits and complications to each line.
The PICC line, by essentially shielding the peripheral vein, allows delivery of more caustic medications that are at the extremes of the pH chart, below 5 or greater than 9, and longer delivery of those medications. These medications or fluids include IV antibiotics, chemotherapy, and TPN (Total Parental Nutrition). Use of the PICC Line comes with potentially more risks such as CLABSI (Central Line Associated Bloodstream Infection), a collapsed lung (Pneumothorax), or blood clot (DVT). Midline use is for non-caustic medications and the risk appears lower for certain infections or embolisms as it is not a central line. Finally, Midlines are less expensive than PICC lines to place and if used properly, can help improve patient outcomes and reduce costs.
Midline Catheter Removal
Midline Catheter Removal usually takes place at the end of treatment or if there are complications with the Midline. Midline Catheter Removal starts with detaching any dressing and medical tape securing the line. The catheter is removed while the patient exhales forcefully to help prevent an air bubble from entering the patient’s blood vessel. This air bubble is described as an embolism and, although rare, can cause heart attacks or strokes. After pressure is applied to the site, a bandage will be placed to cover and protect the site until it heals. Usually, there is no discomfort to the patient during the removal of the Midline Catheter.
Midline Catheter Care
Midline Catheter Care is just as important as proper Midline device placement. Midline Catheter Care is similar to the care of most vascular access devices (VAD) and, if done correctly, enables the catheter to stay clean and to continue working to deliver medications and therapies. This care includes changing the bandage (dressing), flushing the catheter with fluids, and changing the cap on the end of the catheter. This is the best way to prevent complications or infections with the line that would require it to be removed before treatment is completed. Dressing changes are required by the patients who are discharged with the Midline device and are usually performed once per week using sterile techniques. However, a patient must check the dressing daily and change it sooner if the dressing gets dislodged, wet, or soiled. Midline Catheter Care also includes not letting the tubing hang freely, pulling at the tubing, or heavy lifting that may cause the tubing to migrate out.
Vascular Access Specialists
| Vascular Wellness
Vascular Wellness is a team of Vascular Access Specialists that have elevated the clinical evaluation and placement of Midlines and PICCs resulting in the best appropriate line. As client partners, we often influence and increase the correct use of Midlines, both single and double lumens, saving our clients time and money. Vascular Wellness specializes in all aspects of vascular access device (VAD) placement including assessment, insertion, maintenance, difficult placements, and possible removal. Vascular Wellness Specialists are W2 employees who complete comprehensive training that can involve placing 50 to 100 lines per procedure type, follow best practices for line placement for vein preservation and to prevent side effects, and utilize the best equipment and supplies from Bard, a leading supplier to hospitals. Vascular Wellness clinicians can place Ultrasound Guided Basic and Extended Dwell PIVs, Midlines and PICCs, and many clinicians can place advanced devices including Small Bore Central Catheter Lines (such as Internal Jugular Lines and Femoral Lines) and Large Bore Central Catheter Lines (such as Vas Caths for Dialysis and Quad Lumens). Vascular Wellness also provides vascular access training, infection control, and comprehensive administrative support including quality reports and detailed patient records for The Joint Commission surveyors. Vascular Wellness clinicians are Vascular Access Specialists.
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