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Midline Intravenous Peripheral Catheters: Use, Maintenance and Removal (Adult) (1.55)

Midline Intravenous Peripheral Catheters: Use, Maintenance and Removal (Adult) (1.55) - Policies, Clinical, UWHC Clinical, Department Specific, Nursing Patient Care, Cardiovascular and Infusion

1.55



NURSING PATIENT CARE POLICY & PROCEDURE





Effective Date:
July 29, 2016
amended:
Nov. 17, 2017

Administrative Manual
Nursing Manual (Red)
Other _______________

Policy #: 1.55 A

Original
Revision

Page
1
of 6

Title: Midline Intravenous Peripheral Catheters:
Use, Maintenance and Removal (Adult)

I. PURPOSE

To provide procedure for the safe use, maintenance and removal of peripherally inserted
midline intravenous catheters.

II. POLICY

A. In effort to establish a single practice for midline use and application, both of which
are device dependent, University Hospital has adopted exclusive utilization of the
Bard Power Glide Midline Catheter for all midline therapies.
B. Patients admitted with a non-Bard Power Glide midline catheter from an outside
organization will have midline catheter removed and replaced with Bard Power Glide
Midline Catheter if deemed appropriate for intended intravascular therapy.
C. The Bard Power Glide Midline Catheter:
1. May remain indwelling for 29 days
2. May be used for routine blood sampling.
3. May be used for power injections up to 325 PSI.
III. MIDLINE USE AND MAINTENANCE
Midline intravenous catheters are peripheral vascular access devices and should NOT be
mistaken for peripherally inserted central catheters (PICCs).
A. Indications for Use
1. Hospital admission of 5 days or longer
2. Poor venous access
3. Infusions appropriate for midline administration. Refer to Intravenous
Administration of Formulary Medications – Adult – Inpatient/Ambulatory
Clinical Practice Guideline for guidance regarding medications that must be
delivered via a central vascular access device.
B. Placement and Identification
1. Venous Access Team (VAT) will determine if the patient’s clinical needs
meet indication for midline peripheral catheter and will place all midline
catheters utilizing ultrasound technology.
2. Signage will be posted in the patient’s room indicating:
a. Placement site and length of a midline catheter
b. No blood pressure cuff on affected arm
c. Not a central vascular Access device



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C. Immediate Post-Insertion Care
1. Midline catheters may be used immediately after insertion, unless otherwise
indicated by VAT or provider.
2. Replace all existing IV tubing, including secondary sets, filters, needleless
connectors or other add-on disposable devices prior to initiation of
infusions.
3. Assess the dressing in the first 24 hours for accumulation of blood, fluid or
moisture beneath the dressing.
4. Observe for any sign of patient discomfort, discoloration, edema, skin
temperature change, tenderness or bleeding. Notify provider or VAT if
complications occur.
D. Assessment and Documentation
1. RN will perform an assessment every shift. Document assessment in the
patient’s clinical record. The assessment will include:
a. Visual inspection and palpation noting signs of potential complications
including: erythema, tenderness, edema, exudate, bleeding, phlebitis,
infiltration.
b. Dressing integrity (clean, dry, and fully intact) and date.
2. Midline Patency and Flushing Assessment
a. Aspirate for blood return before infusing medications or flushing to
ensure patency of line and validate presence in vessel. Document
quality or absence of blood return.
b. Use only 10 mL syringes for flushing. Flush the lumen between
infusion of medications or drawing blood according to
Flushing/Locking of Venous Access Devices –Pediatric/Adult –
Inpatient/Ambulatory Clinical Practice Guideline.
c. Do not use antimicrobial lock solutions including ethanol for midline
intravenous catheters.
E. Dressing Change
1. Perform Midline dressing change using sterile technique.
2. The Tegaderm CHG dressing is the standard dressing for all Midline
catheters.
a. If the patient has uncontrolled bleeding from the insertion site, the
GuardIVa sponge and Tegaderm Advanced dressing may be used
until hemostasis is achieved. For severe bleeding, a HemCon dressing
may be used instead of GuardIVa sponge.
b. If the patient is allergic to CHG, use the Tegaderm Advanced dressing
alone without CHG.
c. If the patient has sensitivity to Tegaderm, use Sorbaview dressing and
Biopatch.
3. Frequency of Dressing Change by Type
a. Transparent Adhesive Dressing With or Without CHG patch or
GuardIVa sponge.
i. Change dressing and StatLock® every 7 days or immediately if
dressing is wet, or loose, or when close inspection of the site is
necessary.
ii. NOTE: Tegaderm CHG dressings are able to absorb some
blood or moisture without loss of efficacy. Press the CHG


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patch with fingertip to determine extent of saturation. If pitting
remains after pressing, the dressing must be changed.
b. If original dressing does not have CHG impregnated dressing (or
Biopatch if used), add at next dressing change.
4. Assemble Dressing Supplies
• Clean gloves for dressing removal
• Extension tubing and MicroClave
• GuardIVa or Biopatch if appropriate
• Alternate dressing if appropriate (Sorbaview) (CS Item Number
2203481)
5. Steps for a Midline Dressing Change
a. Explain procedure to patient and family.
b. Close door to limit traffic into the room.
c. Perform hand hygiene according to UW Health Clinical Policy 4.1.13,
Hand Hygiene.
d. Don exam gloves.
e. Prime new tubing extension and MicroClave.
f. Disconnect current tubing extension from Midline catheter (may need
to pull dressing from luer connector) and connect new tubing
extension and MicroClave.
g. Secure tubing extension to patient’s arm by placing tape close to the
luer connector to prevent catheter dislodgement during dressing
change.
h. Remove transparent dressing and antimicrobial disc using a stretching
technique to disengage the glue.
i. Remove Statlock.
j. Perform site assessment once dressing is removed.
k. Remove exam gloves and perform hand hygiene.
l. Open sterile dressing kit. If used, place antimicrobial disc on sterile
field.
m. Don sterile gloves.
n. Cleanse and Prep Skin
i. Alcohol swab sticks - Use to remove dried blood from catheter
site and residual glue from catheter.
ii. ChloraPrep® applicator - Use to cleanse skin at and
surrounding CVAD insertion site. Scrub making repeated back
and forth strokes of the sponge for 30 seconds, completely
wetting the 4x5 inch treatment area with ChloraPrep®
applicator. Allow the area to air dry for 30 seconds. Do not
blow dry, blot or wipe away.
iii. Apply skin prep to the area that will be under the perimeter of
the transparent dressing and StatLock®. Allow to air dry.
o. Place StatLock®
i. Loosen doors of StatLock® by opening and closing them once.
ii. Place catheter suture holes over posts of StatLock® and close
plastic doors one at a time. Do not press on patient.
iii. Place anchor pad over prepped securement site, and peel away


Page 4 of 6

paper backing, one side at a time, pressing pad in place.
p. Apply dressing
i. Position transparent dressing centering CHG patch over the
catheter exit site without stretching. Press/rub dressing to
ensure adherence.
q. Label the dressing with date of dressing change. Document on patient
flowsheet.
r. Document dressing change in patient’s clinical record.
F. Blood Sampling
1. RNs may access midline catheters for blood sampling.
2. Do not collect blood directly from midline catheter using a blood tube
holder and blood collection tubes. Excessive vacuum will flatten the vein
limiting the ability to collect the sample.
3. Cleanse the needleless connector with an alcohol wipe for 15 seconds and
allow to dry for 15 seconds.
4. Withdraw waste 5-10 mL blood into 5 mL syringe(s).
5. Perform blood collection using a 3 or 5 mL syringe. Draw blood slowly by
pulling gently back on plunger. If blood flow into syringe slows, stop, wait
a few seconds to allow vein refilling, then resume collection. This will
reduce compression of the vein and the risk for hemolysis of the sample.
6. Transfer samples from the syringe into the tubes following the standard
order of draw. Refer to Order of Draw for Blood Collection posted on U-
Connect.
7. Flush midline catheter after collecting blood sample according to Flushing
Guidelines for Venous Access Devices under the Drug Use Guidelines on
U-Connect.
8. Change MicroClave if blood is visible after flushing.
G. Blood Cultures
1. Refer to UW Health Policy 2.5.6, Blood Cultures for Adult Patients for
collecting blood cultures from a midline catheter.
2. Intravascular lines, including Midlines, should not be cultured unless all
attempts at peripheral venipuncture have been exhausted.
H. Management of Complications
1. Report suspected midline catheter complications to the provider (examples:
catheter occlusion, phlebitis, or infiltration). The Venous Access Team may
be consulted regarding management of complications if indicated. In most
cases, the midline catheter will be discontinued if complications occur.
2. Occlusion - Catheter clearance will not be performed as with central lines.
Consult provider or vascular access team if midline intravenous catheter is
occluded.
I. Patient Teaching Resource
1. Health Facts For You #7831, Your Midline Intravenous Catheter

IV. MIDLINE CATHETER REMOVAL

A. Bedside RNs will remove midline catheters. Verify provider’s order for discontinuing
the midline catheter prior to removal.
B. Explain procedure to patient.


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C. Assemble supplies: alcohol swabs, sterile 4x4 gauze, sterile 2x2 gauze, transparent
dressing.
D. Position patient with extremity supported.
E. Perform hand hygiene according to UW Health Clinical Policy 4.1.13, Hand Hygiene
and don clean gloves.
F. Remove dressing, Biopatch®, and StatLock®, using alcohol swabs to loosen
adhesive.
G. Grasp catheter near insertion site.
1. Remove slowly. Do not use excessive force.
2. If resistance is felt, stop removal. Apply warm compress and wait 20-30
minutes, then resume removal procedure.
H. Once catheter is removed, hold direct pressure on insertion site with 4x4 gauze, until
hemostasis is achieved.
I. Apply a sterile 2x2 gauze with small transparent adhesive dressing to exit site and
leave in place for 24 hours.
J. Document removal of midline intravenous catheter and confirmation of intact tip in
patient’s clinical record.

V. DISCHARGING WITH A MIDLINE CATHETER

A. Discharge planning should include review of remaining duration of use (29 days from
insertion date).
1. A new midline should be placed if current midline must be discontinued
within 5 days after discharge. Consider the intended post-hospitalization
duration of therapy.
2. Inform transferring facility and/or home health agency, patient and/or family
the date when the midline must be discontinued.
B. Prior to patient discharging from hospital, flush and check patency of midline
catheter.
C. Provide patient and family members with Health Facts For You 7831,Your Midline
and Intravenous Catheter.
D. Transferring facility and/or home health agency will assume care of Midline.
E. Determine where patient will obtain future supplies and education on line care.
Involve inpatient case managers, and clinic staff or local hospital/agency.

VI. UW HEALTH CROSS REFERENCES

A. Flushing/Locking of Venous Access Devices –Pediatric/Adult –
Inpatient/Ambulatory Clinical Practice Guideline.
B. Health Facts For You #7831, Your Midline Intravenous Catheter
C. UW Health Clinical Policy 2.5.6, Blood Cultures for Adult Patients
D. UW Health Clinical Policy 4.1.13, Hand Hygiene
E. Nursing and Patient Care Policy 1.56 AP, Central Vascular Access Device Use,
Maintenance and Removal (Adult & Pediatric)




Page 6 of 6

VII. REFERENCES

A. Anderson, R. (2004). Midline catheters. The middle ground of IV administration.
Journal of Infusion Nursing 27(5) 313-320.
B. Gorski, L.A., Hagle, M.e., Bierman, S. (2015). Intermittently delivered IV medication
and pH: Reevaluating the evidence. Journal of Infusion Nursing 38 (1) 27-46.
C. Hospital Infection Control Practices Advisory Committee (HICPAC) (2011).
Guidelines for the Prevention of Intravascular Catheter-Related Infections.
D. Infusion Nurses Society (2011). Intravenous Nursing Standards of Practice. Journal
of Infusion Nursing, 34 (1S), S1-S96.

VIII. REVIEWED BY

Clinical Infection Control Practitioner
Nurse Manger, Venous Access Team
Clinical Nurse Specialist, Infusion
Clinical Nurse Specialist, Quality
Nursing Education Specialist
UWHC Venous Access Team
Nursing Patient Care Policy and Procedure Committee, July 2016

SIGNED BY

Beth Houlahan, DNP, RN, CENP
Senior Vice President, Chief Nurse Executive