A midline catheter, defined by Infusion Nurses Society, is a vascular access device intended for placement into a peripheral vein in the upper arm; basilic, cephalic, or one of the two brachial veins, with the internal tip located level at or near the level of the
axilla and distal to the shoulder. Standard midlines can range from 10 to 20 centimeters in length and can have a single lumen or double lumen. They are typically used for infusion and short-term intravenous therapies.
When to Choose Midlines for Your Patient
The CDC recommends catheters are selected based on the intended purpose and duration of use, known infectious and non-infectious complications, and experience of individual catheter operators. INS Guidelines indicate 6 considerations when choosing midline catheters for your patient:
- Assess infusate characteristics and planned duration of infusion therapy for tolerability by peripheral veins.
- Use a midline catheter for medications and solutions such as antimicrobials, fluid replacement, and analgesics with characteristics that are well-tolerated by peripheral veins.
- Assess the clinical benefit of using a midline catheter that inhibits bacterial attachment and biofilm formation.
- Do not use midline catheters for continuous vesicant therapy, PN, or infusates with extremes of pH or osmolarity.
- Increase catheter site surveillance when administering intermittent infusions of known irritants and vesicants due to increased risk of phlebitis or extravasation.
- Avoid the use of a midline catheter when the patient has a history of thrombosis, hypercoagulability, decreased venous flow to the extremities, or end-stage renal disease requiring vein prevention.
Why are Midline Catheters Beneficial for Your Patients?
INS Practice Criteria says midline catheters are intended to serve as a safe access option unlikely to be dislodged; providing a better option for clinicians wanting to give medications to patients but not wanting to have extravasation occur. Midlines are made to be inserted with ultrasound guided venipuncture. ICU Management Practice states “ultrasound guidance allows clinicians to see their anatomical target and surrounding structures, such as soft tissue, vessels, and nerves in real time as the needle advances to the procedure’s endpoint, instead of working blindly. In addition, ultrasound visualization can also help clinicians assess the patency and diameter of the target vein.” This allows a lower risk of mechanical or infectious complications, simplifies the number of procedures, and overall reduces the numbers of insertions.
Here at Health Line, all our CT midline kits are designed with the INS and CDC guidelines in mind. Our MST kits include: a catheter, guidewire, safety introducer needle, tearaway introducer/dilator, safety scalpel, tape measure, Grip-Lok® stabilization device, and midline wrist band. Our midlines are the ideal choice for clinicians and patients who are looking for a reliable, short-term access device that will provide a low complication rate, long dwell time, and high rate of first-attempt placement.
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Bahl, A., Karabon, P., & Chu, D. (2019). Comparison of Venous Thrombosis Complications in Midlines Versus Peripherally Inserted Central Catheters: Are Midlines the Safer Option? Clinical and Applied Thrombosis/Hemostasis. https://doi.org/10.1177/1076029619839150
Chopra, V., Kaatz, S., Swaminathan, L., Boldenow, T., Snyder, A., Burris, R., Flanders, S. (2019, September 01). Variation in use and outcomes related to midline catheters: Results from a multicentre pilot study. Retrieved January 29, 2021, from https://qualitysafety.bmj.com/content/28/9/714
Gorski, L., Hadaway, L., Hagle, M. E., McGoldrick, M., Orr, M., & Doellman, D. (2016). Infusion therapy standards of practice. Norwood, MA: Wolters Kluwer.
Gorski LA, Hadaway L, Hagle ME, et al. Infusion therapy standards of practice. J Infus Nurs. 2021;44(suppl 1):S1S2-S224. Doi:10.1097/NAN.0000000000000396
Mandavia, D. (2021, January 25). Ultrasound-Guided Procedures: Financial and Safety Benefits. https://healthmanagement.org/c/icu/issuearticle/ultrasound-guided-procedures-financial-and-safety-benefits
Rezaie, Salim. “Midline IV Catheters.” REBEL EM – Emergency Medicine Blog, 13 Feb. 2020, rebelem.com/midline-iv-catheters/.
Spiegel RJ et al. The Utility of Midline Intravenous Catheters in Critically Ill Emergency Department Patients. Ann Emerg Med 2019. Mandavia, D. (2021, January 25). Ultrasound-Guided Procedures: Financial and Safety Benefits. https://healthmanagement.org/c/icu/issuearticle/ultrasound-guided-procedures-financial-and-safety-benefits