Standard ways to obtain vascular access, other than a basic Peripheral IV, include the Extended Dwell Peripheral IV, Midline and PICC, as listed in the order of clinical progression.  Each method provides Vascular Access to the patient’s veins for uses such as intravenous therapy and diagnostic testing of the blood.

The Extended Dwell Peripheral IV is the least intrusive catheter of the mix as it is inserted in the mid arm.  If the Extended Dwell Peripheral IV is not clinically appropriate, the Midline (another non-Central Venous Catheter (CVC)), is evaluated for use.  The Midline is inserted just above the elbow but the tip does not end in a central vein and thus, tends to have less complications that a PICC.  The PICC (Peripherally Inserted Central Catheter) is inserted in a vein just above the elbow and weaved around the shoulder to inside the Superior Vena Cava (SVC), a vein just above the heart.  The SVC is a large vein that allows caustic medications to be received and diluted before being dispersed into the bloodstream by the heart.

What are the main similarities among Extended Dwell Peripheral IVs, Midlines and PICCs?

Each of the Extended Dwell Peripheral IVs, Midlines and PICCs enable longer vascular access to administer medication and fluids than a basic Peripheral IV and as a result, less needle sticks.  The VAD chosen will depend on many factors such as medical history, including vein use, medical treatment, patient commitment to line maintenance, and activity level.  Provided no complications or other requirement for removal, the VAD chosen will stay until treatment completion.

The insertion and guidance of the needles of the Extended Dwell Peripheral IVs, Midlines and PICCs are all carefully performed using an ultrasound.  The Modified Seldinger Technique (MST) is typically used for correct placement.  Unlike Extended Dwell Peripheral IVs and Midlines, the placement of the PICC must be confirmed as the PICC is inserted near the heart.  PICC placement can be confirmed via Electrocardiogram (ECG) Tip Confirmation technology or X-Ray.  Line maintenance is generally similar across all lines including dressing cleaning and changes as the line is generally critical to treatment and infection control must be a priority.

What are the main differences among Extended Dwell Peripheral IVs, Midlines and PICCs?

The main difference among Extended Dwell Peripheral IVs, Midlines and PICCs is that the PICC line is placed near the heart and the Extended Dwell Peripheral IVs and Midlines are inserted and remain in peripheral veins.  As a result, PICC lines are used when the IV medications or fluids may irritate veins or when medications are to be given over a longer period of time.  Examples of medications are IV antibiotics, chemotherapy, and TPN (Total Parental Nutrition).  Furthermore, PICC lines can handle multiple medications as each line can have more than 1 lumen.  However, the PICC line can have additional potential complications and thus, it must be inserted and placed by a skilled clinician who, following best practices, can successfully mitigate many of the risks.

If you require Vascular Access or want to learn more, speak to the team at Vascular Wellness today.

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