Marcia Malone-Tedder
Houston Methodist Willowbrook Hospital, USA
Title: Introduction of midline IV option: Preparing staff for practice changes
Biography
Biography: Marcia Malone-Tedder
Abstract
IV access is a continuing challenge for nurses and patients report dissatisfaction with multiple IV sticks. Typically, there are two options for IV access: traditional peripheral IV or central line placement. Often PICC lines are placed in patients with difficult or limited venous access. Midline IV catheters offer an additional alternative for patients with limited IV options and can be used for long term IV therapy up to 29 days. While midline catheters have been available, our facility did not have a midline product and was not using them for IV therapy. A midline product trial was initiated, but there were concerns regarding confusion between midlines and PICC lines and possible misuse of midlines as PICC lines. In order to address these concerns, a comprehensive education program was developed for nursing staff and physicians that delineated the differences and similarities between midlines and PICC lines. An IV Access Decision Algorithm was developed to guide clinicians in selecting the appropriate option. In addition to ordering a PICC or a midline, clinicians could consult the vascular access team to assess and recommend IV access. Over a 6 month trial period, 150 midlines were placed. No TPN or medications requiring central line administration were given; however, Activase (Cathflo) was given twice in midlines misidentified as PICCs. Three physicians documented midlines as PICC lines and two nurses referred to midlines as PICC lines when troubleshooting, but there was no evidence that the midline was mistakenly used as a PICC. Midline IVs are a viable option for many patients, but as midline IVs become more common, more education is needed to ensure that midlines remain a safe alternative for IV access.