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.
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 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.
Midline Catheter Use
Midline Use is clinically appropriate as follows:
• Unable to obtain Peripheral IV or Extended Dwell Peripheral IV
• Extended therapy requiring 29 days of 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.
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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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