The insertion site is the upper limb-specifically in the middle third of the arm (basilic, brachial and cephalic veins). Administration of blood and blood products.Antibiotic therapy in serious infections: endocarditis, osteomyelitis.Administration of electrolytes, feeding aid with osmolarity 7 days.Temporary access while awaiting final access.Poor peripheral venous tree DIVA patients.Midclavicular (or clavicular) midline (or echo-midline): 20-25 cm catheter that is always inserted in deep veins of the arm with the tip positioned in the thoracic section of the axillary vein or up to the subclavian vein.Ī midline must be placed in the following cases:.Mini-midline: 8-10 cm catheter that can be inserted in the forearm or arm with a tip position that does not go beyond the axillary cavity. ![]() Although handling and maintenance do not require the intervention of a vascular access specialist, a series of requirements must be met to ensure proper functioning.Īccording to the GAVeCeLT manual on PICCs (peripherally inserted central catheters) and midline catheters, there are two types of midlines: Midline catheters must be placed by trained and specialised personnel. All rights reserved.The midline catheter growth has been exponential since it is a resource that allows a notable improvement in the management of vascular access for medium-term treatments compatible with peripheral perfusion. Midline midline catheter venous access devices.Ĭopyright © 2016 Elsevier Inc. Its utilization in the ED in patients deemed to require prolonged hospitalization or to have difficult-to-access peripheral vasculature could reduce cost and risk to patients. The MC is a versatile venous access device with a low complication rate, long dwell time, and high rate of first-attempt placement. Placement of a MC includes modified Seldinger and accelerated, or all-in-one, Seldinger techniques with or without ultrasound guidance, with a high rate of first-attempt success. Cost of insertion of a MC has been cited as comparable to three PIVs, and their use has been associated with significant cost savings when placed to avoid prolonged central venous access with CVCs or in patients with difficult-to-access peripheral veins. The average dwell time of a MC is reported as 7.69-16.4 days, which far exceeds PIVs (2.9-4.1 days) and is comparable to PICCs (7.3-16.6 days). Midline catheters (MC) offer a comparable rate of device-related bloodstream infection to standard peripheral intravenous catheters (PIV), but with a significantly lower rate than peripherally inserted central catheters (PICC) and central venous catheters (CVC) (PIV 0.2/1000, MC 0.5/1000, PICC 2.1-2.3/1000, CVC 2.4-2.7/1000 catheter days). To compare venous access device indications and complications, highlighting the use of midline catheters as a potentially cost-effective and safe approach for venous access in the ED. Appropriate device selection is warranted on initial patient contact to minimize risk and cost. The availability of trained personnel and dedicated teams using ultrasound-guided insertion techniques in technically difficult situations may also impact the selection. ![]() ![]() The patient's clinical status, ongoing need for laboratory investigation, and intravenous therapeutics guide the size, type, and placement of the catheter. Venous access in the emergency department (ED) is an often under-appreciated procedural skill given the frequency of its use.
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