Midlines, Extended Dwell Peripheral IVs, and Peripheral IVs are the most common and basic methods for obtaining Vascular Access using Non-Central Venous Catheter Lines. This page describes, in general, when these lines are clinically appropriate.
Peripheral IVs are the most basic and least intrusive method for obtaining Vascular Access provided it is clinically indicated and appropriate, which means the following:
• Neutral pH IV medications or fluids (pH >5 or <9)*
• IV medication or fluid Osmolality <900 *
• Successful PIV access in < 3 attempts
• Venipuncture appropriate for routine lab work
• Anticipated PIV need <5 days**
If the preceding is satisfied, then a Peripheral IV (PIV) is appropriate. Both upper arms and right side of neck should not be accessed in order to preserve the Insertion Sites in case needed for a Midline, PICC or IJ Catheter. If after 3 unsuccessful Peripheral IV attempts, an Extended Dwell Peripheral IV or Midline, in that order, should be considered.
Extended Dwell Peripheral IV
Extended Dwell Peripheral IVs
Extended Dwell Peripheral IV (which is Ultrasound Guided) is the next step for Vascular Access if clinically indicated or a Peripheral IV is not successful. Indications of use include:
• Diminished Access Insertion Sites for Peripheral IV
• History of difficult Peripheral IV Access
• More than 3 unsuccessful Peripheral IV Access attempts
• Veins deeper than 2 cm
• Infusion or fluids needed for up to 29 days
• Short term bridge to therapy prior to Midline or Central Access (e.g., PICC)
• Improved blood return over PIV for lab sampling
The Midline Catheter is the last step prior to moving to a Central Venous Catheter Line. Assuming all Peripheral IVs and Extended Dwell Peripheral IV’s indications are met, then a Midline Catheter is appropriate if the following indications of use are present:
• Unable to obtain Peripheral 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
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