Midlines

Midlines are versatile and effective vascular access devices when Peripheral IVs and Extended Dwell PIVs are not clinically indicated. Midlines are not central lines and thus, can lead to cost savings and reduced risk of complications that may come from a central line. This page describes Catheter Placement, Insertion, Use, and some of the differences between Midlines and PICC Lines.

VASCULAR ACCESS SPECIALISTS

As Vascular Access Specialists, Vascular Wellness nurse clinicians are Vascular Access Board Certified (VA-BC), insured, skill-verified, and salaried W2 employees.  Vascular Wellness requires bi-annual skill verification ensuring adherence to proprietary policies, procedures, competencies, and best practices.  We focus on holistic and comprehensive care and do not follow the pay per procedure model plus performance bonuses used by others that may create some adverse incentives for speed at the bedside versus holistic medical care helping to ensure the placement of the right line at the right time, the first time.  In fact, Vascular Wellness employs a Director of Research and Development who not only helps us stay up to date on best practices but helps us continue to innovate and improve upon Vascular Access Services.

Vascular Access Specialists from Vascular Wellness

Vascular Access Specialists practice holistic medical care, meaning talking to the patient, addressing questions and fears, and performing a comprehensive medical review.  Prior to delivering any Vascular Access procedure, the Vascular Wellness clinician reviews the patient’s medical record, including history and lab reports, and independently verifies and confirms the doctor’s order.  If our clinician has questions or disagrees with the prescribing doctor, the clinician will consult with the doctor. Our Vascular Access Specialists have earned the trust of many doctors, and such doctors will defer to the clinician’s recommendation by ordering a “consult” as compared to a specific line.  Patient safety and vein preservation are critical – which is why a holistic, comprehensive evaluation and Advanced Lines are significant.  Other companies claiming to be Vascular Access Specialists may not follow this same approach frustrating medical doctors and nurses primarily because those 1099 Contractor PICC nurses do not place Advanced Lines (i.e, no options other than PIVs, Midlines, and PICCs) and get paid on a pay per procedure model.

In states where nurses are permitted, as Vascular Access Specialists, Vascular Wellness clinicians can provide immediate X-Ray Clearance of lines when tip confirmation is not available or appropriate and X-Ray confirmation must be used. This saves money, time, and coordination with a Radiologist or other doctor and enables the lines to be used immediately to avoid delaying treatment. Quicker therapy leads to better outcomes.

As Vascular Access Specialists, Vascular Wellness uses top rated and hospital preferred supplies from Becton Dickinson, formerly Bard (BD). Superior supplies and services help mitigate the potential for poor outcomes such as bad placement, clotting, infections, and other adverse events.  Other companies that are not Vascular Access Specialists may opt for inferior supplies and older equipment.

Midline

The Midline is generally inserted by PICC Nurses, and these PICC Nurses can be internal or external depending on the healthcare provider. Usually, a group of PICC Nurses is referred to as a PICC Team. PICC Services is a term used often to describe vascular access services of standard lines including Ultrasound Guided PIVs, Midlines, and PICCs. PICC Line Services typically do not include advanced lines such as Small Bore Internal Jugular Lines, Femoral Lines, and Axillary Lines as well as Large Bore Lines including Vas Caths for Dialysis and Quad Lumen Lines. The main point to remember is that a PICC Nurse will place a Midline among other vascular access devices.

Midline Catheter

Midlines Illustration

Midline Catheter Placement or Procedure

Midline Catheter Placement generally starts in a vein just above the elbow but does not end in a central vein or near the heart. An experienced PICC Nurse will not place a needle in the elbow area as such is more prone to bacteria and infection. This procedure holistically includes a review of the patient and the patient’s medical history and records, the Midline Catheter Placement itself, and then careful clinical documentation. Midline Catheter Placement and Procedure are not clinically appropriate in all cases and when there are contraindications, central line devices such as PICC Lines must be considered as well as other more advanced lines.

Midline Insertion or Placement

Midline Insertion is carefully performed using an ultrasound, and control and guidance of the needle is paramount. The more experienced PICC Nurses use needle visualization instead of needle guides for the Insertion. Needle visualization is preferred and enables the PICC Nurse to be more agile and flexible. Correct Insertion is usually done using the Modified Seldinger Technique (MST). While correct Midline Placement is critical, it does not need to be confirmed with X-Ray or ECG as it is not placed near the heart.

reducing central line bloodstream infection (CLABSI) by strong midline program where therapy is appropriate

Midline Catheter Use

Midline Uses

Midline Use is clinically appropriate as follows:
• Unable to obtain Peripheral IV or Extended Dwell Peripheral IV
• Extended therapy requiring IV access
• Exhausted or diminished lower arm Access Insertion Sites
• Dehydration or poor peripheral venous volume

Midline Uses primarily include when IV Access is difficult or when IV medications or fluids are to be given over a longer period of time. These Uses vary and are very effective and efficient in bridging the gap between an IV and a central line such as a PICC.

What is a Midline Catheter Used for

Midline Catheter Use continues to evolve. Vascular Wellness is a big advocate of Midlines when clinically appropriate as PICC Lines can be over prescribed as a default when Midline Catheter Use is a better choice. Vascular Wellness supports training on Midline Catheter Use as such can be very helpful in educating staff due to potential confusion around these lines. Furthermore, these Catheters can have more than 1 lumen (ie, tubing and cap) meaning that they can handle multiple medications with each medication being given in a single lumen to avoid mixing. Unlike many other PICC Service companies, Vascular Wellness inventories and places double lumen Midline Catheters when clinically indicated enabling greater flexibility and reduced cost.

Difference between Midline and PICC Line

The difference between these lines stems from the main point that the Midline is not a central line and the PICC Line is a central line. This difference leads to reduced costs and a lower risk that comes from a central line. 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 two lines.

As client partners, we often influence and increase the correct use of Midlines saving our clients time and money. Care and maintenance of Midlines is critical and similar to a central line to avoid risk of infection. See our page, PICC Line and Midline Care for proper care of both of these Lines.

Peripherally Inserted Central Catheters

Peripherally Inserted Central Catheters or PICCs provide the next option for vascular access. See PICC Lines

PICC Line

PICC Line

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Vascular Wellnesssm provides clinical vascular access nursing services at the bedside across the Southeast to a diverse client base including Tertiary Hospitals, Community Hospitals, Long Term Acute Care Hospitals, Skilled Nursing Facilities, Surgical and Outpatient Centers,  Hospice, and At-Home care.

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Cary, NC 27519
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