Qian et al (2014) recently published an article on “the use of 8-cm 22G Seldinger catheters for intravenous access in children with cystic fibrosis” in the Journal of Vascular Access. The abstract in available here. In this small study the authors investigated the use of midline catheters for children. I read with interest in the abstract that “rates of local complications were high, but there were no serious adverse outcomes”. As an avid user of midlines I considered this remark in light of my own experience. I can think back to more than a decade ago when I first started using midlines and the local complications that we encountered. Of course, as a service that counts outcomes we can identify these issues easily. However, as a practitioner that believes we should be working towards zero for all IV related problems I wanted to minimise these issues of phlebitis, occlusion, infiltration etc that are sometimes linked with midlines.
What have we done over the years to reduce local complications with midlines? This brief list is not an exhaustive list but it could be a place to start.
“We implemented and continue to use a positive pressure needlefree device. This virtually eliminated problems of occlusion. In addition, the use of the particular positive pressure needlefree device did not negatively impact on our midline infection rate. Our midline infection rate remains virtually nil.”
“Our securement approach includes the IV dressing and its combined securement strip. We do not use additional third party securement devices for our midlines. Our dislodgement rate is virtually nil.”
“Finally, the issue of phlebitis, upper extremity deep vein thrombosis (DVT) etc. It is vital that midline users specify which drugs are suitable for midline use. In our experience this approach has ensured our phlebitis and DVT rate is virtually nil.”
Our midlines are patient specific and virtually all reach the end of treatment. Hope this helps.
Qian, S.Y., Horn, M.T., Barnes, R. and Armstrong, D. (2014) The use of 8-cm 22G Seldinger catheters for intravenous access in children with cystic fibrosis. The Journal of Vascular Access. July 4th. [epub ahead of print].