What is the latest information on infusing Vancomycin through Midlines? I do not advocate it and instruct staff against it, however, there is no formal policy against it in our hospital. Pharmacy and Interventional Radiologist  both claim it is OK to do. Where can i get evidence to present to them that this is not best practice?

Danny Vasquez RN

Not specific research,

Not specific research, however this recommendation to avoid vanco through a midline is based on an evidence-based theory. The midline tip location is much deeper in the tissue than a vein of the hand or forearm. This tip location is much closer to large nerves and major arteries. The midline tip location is still a peripheral vein with a diameter that is between 6 to 10 mm, depending upon the choice of vein and the patient. Signs of any complication would take a longer period of time to be detected by examination of the skin and in this time, more serious tissue damage can be done. Vancomycin is a vesicant medication. So based on all of these factors, midlines are not recommended for vancomycin. Think of midlines as a replacement for multiple peripheral catheters. They can never be considered as a replacement for a CVC. The SVC diameter is about double the diameter of the midline tip location or about 20 mm with a much more rapid flow rate of 2000 mL of blood per minute. So no midlines for vancomycin or any other vesicant medication.Lynn

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

Not specific research,

Not specific research, however this recommendation to avoid vanco through a midline is based on an evidence-based theory. The midline tip location is much deeper in the tissue than a vein of the hand or forearm. This tip location is much closer to large nerves and major arteries. The midline tip location is still a peripheral vein with a diameter that is between 6 to 10 mm, depending upon the choice of vein and the patient. Signs of any complication would take a longer period of time to be detected by examination of the skin and in this time, more serious tissue damage can be done. Vancomycin is a vesicant medication. So based on all of these factors, midlines are not recommended for vancomycin. Think of midlines as a replacement for multiple peripheral catheters. They can never be considered as a replacement for a CVC. The SVC diameter is about double the diameter of the midline tip location or about 20 mm with a much more rapid flow rate of 2000 mL of blood per minute. So no midlines for vancomycin or any other vesicant medication.Lynn

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

Midlines

Thanks Tim and I plan to!

Midlines

Thanks Lynn-

     Do you know of any research published that is specific to Midlines not short IVs and Vancomycin?

Look for this resources

Look for this article on my blog.

http://hadawayassociates.blogspot.com/2007/05/changing-physicians-percep...

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

Danny, I'd be asking both

Danny,

I'd be asking both your departments (pharmacy / radiology) for formally comment on their decision to do this and provide evidence-based research that supports their decision to go AGAINST most on this issue.

Get them to put their money where there mouth is!!

Tim Spencer
That CVC guy from Australia :-}