Catheter choice based on the estimated duration of treatment typically guides selection. Any patient requiring IV infusions for more than a few days may benefit from a Midline catheter. When a PIV fails in less than 24 hours, Midline or PICC may be better options. Geriatric and pediatric patients can benefit from Midline catheters as a more reliable form of vascular access that will not fail as often as a PIV. Midlines are an excellent option for patients when their medications and solutions are generally isotonic and non-irritating. According to the CDC, Midline catheters are replaced only when there is a specific indication for removal, such as a complication or completion of therapy (O’Grady, 2011). Midline catheters typically do not last without complications for more than a few weeks but can provide patients with a longer, more reliable access alternative to the short PIV. Central venous catheters, such as PICCs, and the associated risk of infection should be avoided if the medications included in the treatment plan are not irritating and do not require a duration that exceeds four weeks. The CDC states to use a Midline catheter or PICC instead of a short peripheral catheter if the duration of IV therapy will likely exceed six days (O’Grady et al., 2011). Generally, 8-25cm long, Midline catheters are inserted with ultrasound guidance into the larger diameter veins of the upper arm and tend to last longer than a PIV. Midline catheters are a type of peripheral catheter, longer than short PIVs, and indicated for patients requiring therapy for more than five days but less than a few weeks (Gorski et al., 2021 Chopra et al., 2015). According to the Centers for Disease Control (CDC) (O’Grady et al., 2011), Midline catheters should be selected based on the intended purpose and duration of use, known complications, and experience of individual catheter inserters. Midline catheters may have different lengths and configurations, allowing Seldinger, Modified Seldinger, and Accelerated Seldinger insertion methods. In addition, scalp veins and veins of the lower extremities are optional locations for Midline catheters in neonatal patients. While there are many different types of Midline catheters, as determined by the Infusion Nurses Society as an intravenous (IV) catheter inserted through a peripheral vein of the upper arm via the basilic, cephalic, or brachial veins with the terminal tip located at the level of the axilla for children and adults (Gorski, et al., 2021). However, Midline catheter insertions are another story.įirst, let us define a Midline catheter. Whenever possible, central catheter insertions, even PICCs, are avoided to sidestep the issue of central line-associated bloodstream infections (CLABSI). We know that peripheral intravenous catheter (PIV) insertions are the mainstay for delivering acute care medication infusions, with the vast majority of patients receiving a PIV immediately upon admission. One of the most common clinical questions I encounter is, when is it appropriate to choose a Midline versus a peripherally inserted central catheter (PICC)? This question requires consideration for peripheral or central access, determination of risk, and evaluation of the treatment type, duration, and future needs of the patient.
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