\u2022 Midclavicular (or clavicular) midline (or echo-midline):<\/strong> 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.<\/p>\n\n\n\n <\/p>\n\n\n\n A midline must be placed in the following cases:<\/p>\n\n\n\n \u2022 Poor peripheral venous tree; DIVA patients <\/p>\n\n\n\n <\/p>\n\n\n\n The insertion site is the upper limb\u2014specifically in the middle third of the arm (basilic, brachial and cephalic veins).<\/p>\n\n\n\n Previous ultrasound mapping is used to view the veins in this area (even at shoulder level) in the transverse or longitudinal axis, depending on the position of the probe. For this purpose, it is recommended to use the RaPeVA method (from the GAVeCeLT group) to perform a rapid ultrasound assessment of the peripheral veins.<\/p>\n\n\n\n <\/p>\n\n\n\n \u2022 Flexures This ultrasound-guided technique makes it possible to cannulate deep veins of the arm such as the basilic, brachial and cephalic, depending on the course and calibre.<\/p>\n\n\n\n There are two insertion techniques: the Seldinger and the Micro Seldinger technique.<\/p>\n\n\n\n > Before preparation:<\/strong><\/p>\n\n\n\n \u2022 Active identification of the patient > Preparation:<\/strong><\/p>\n\n\n\n 1. Handwashing 1. Puncture of the selected vein according to the ultrasound-guided technique, then, insertion of the catheter <\/p>\n\n\n\n Maintenance dressings are carried out every 7-10 days or when they get dirty, become loose, or contain blood.<\/p>\n\n\n\n Here are the steps to follow: The most common midline complications are phlebitis, infection, occlusion, thrombosis, extravasation, and skin lesions.<\/p>\n\n\n\n <\/p>\n\n\n\n Catheter removal is a simple procedure and must be carried out in the following cases:<\/p>\n\n\n\n \u2022 Catheter not necessary or unsuitable The procedure consists of following strict asepsis measures, culturing the tip of the catheter (in case of infection) and recording the data in the patient\u2019s file.<\/p>\n\n\n\n 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…<\/p>\n","protected":false},"author":141,"featured_media":41871,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_et_pb_use_builder":"","_et_pb_old_content":"","_et_gb_content_width":"","footnotes":""},"categories":[844],"tags":[885,144,884],"class_list":["post-41682","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-vascular-access","tag-maintenance","tag-midline","tag-placement"],"acf":[],"_links":{"self":[{"href":"https:\/\/campusvygon.com\/global\/wp-json\/wp\/v2\/posts\/41682","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/campusvygon.com\/global\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/campusvygon.com\/global\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/campusvygon.com\/global\/wp-json\/wp\/v2\/users\/141"}],"replies":[{"embeddable":true,"href":"https:\/\/campusvygon.com\/global\/wp-json\/wp\/v2\/comments?post=41682"}],"version-history":[{"count":8,"href":"https:\/\/campusvygon.com\/global\/wp-json\/wp\/v2\/posts\/41682\/revisions"}],"predecessor-version":[{"id":47784,"href":"https:\/\/campusvygon.com\/global\/wp-json\/wp\/v2\/posts\/41682\/revisions\/47784"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/campusvygon.com\/global\/wp-json\/wp\/v2\/media\/41871"}],"wp:attachment":[{"href":"https:\/\/campusvygon.com\/global\/wp-json\/wp\/v2\/media?parent=41682"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/campusvygon.com\/global\/wp-json\/wp\/v2\/categories?post=41682"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/campusvygon.com\/global\/wp-json\/wp\/v2\/tags?post=41682"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}![\"Body-with-veins-midline\"](\"https:\/\/campusvygon.com\/global\/wp-content\/uploads\/sites\/10\/2022\/04\/Body-with-veins-midline.jpg\")
<\/figure>\n\n\n\nIndications<\/h2>\n\n\n\n
\u2022 Temporary access while awaiting final access
\u2022 Administration of electrolytes, feeding aid with osmolarity < 800-850 mOsm\/L (1)
\u2022 Core therapy involving complications
\u2022 Osmolarity < 800-850 mOsm\/L (1)\u00a0and\/or pH between 5-9
\u2022 Treatment > 7 days
\u2022 Antibiotic therapy in serious infections: endocarditis, osteomyelitis
\u2022 Blood collection (2)
\u2022 Blood transfusion<\/p>\n\n\n\nNecessary material<\/h2>\n\n\n\n
![\"Equipment-required-to-place-a-midline\"](\"https:\/\/campusvygon.com\/global\/wp-content\/uploads\/sites\/10\/2024\/03\/Equipment-required-to-place-a-midline.png\")
<\/figure>\n\n\n\nUltrasound examination<\/h2>\n\n\n\n
![\"Longitudinal-vs-transversal-axis\"](\"https:\/\/campusvygon.com\/global\/wp-content\/uploads\/sites\/10\/2023\/12\/Longitudinal-vs-transversal-axis.jpg\")
<\/figure>\n\n\n\nWhat to avoid<\/h2>\n\n\n\n
\u2022 Veins with the presence of phlebitis
\u2022 Thrombosed or varicose veins
\u2022 Limbs with lymph node dissection
\u2022 During the recognition of structures, rule out the Mickey Mouse area: the course of the brachial artery (Mickey Mouse\u2019s head) runs very close to the brachial veins (Mickey Mouse\u2019s ears) that may be options for cannulation. However, in this section, it is not recommended since the artery and the median nerve are very close.<\/p>\n\n\n\n <\/h2>\n\n\n\n
MIDLINE Installation technique<\/h2>\n\n\n\n
Insertion<\/span><\/h4>\n\n\n\n
<\/h2>\n\n\n\n
![\"Catheter-Insertion-Seldinger-technique\"](\"https:\/\/campusvygon.com\/global\/wp-content\/uploads\/sites\/10\/2024\/02\/Catheter-Insertion-Seldinger-technique.png\")
<\/figure>\n\n\n\n <\/h4>\n\n\n\n
![\"Catheter-Insertion-Micro-Seldinger-Technique\"](\"https:\/\/campusvygon.com\/global\/wp-content\/uploads\/sites\/10\/2024\/03\/Micro-Seldinger-Technique.png\")
<\/figure>\n\n\n\n <\/h4>\n\n\n\n
<\/h4>\n\n\n\n
Process<\/span><\/h4>\n\n\n\n
\u2022 Inform the patient of the procedure to be followed<\/p>\n\n\n\n
2. Place the patient in a supine position with the arm at a right angle to the chest.
3. Ultrasound mapping (RaPeVA) and vein selection
4. Handwashing
5. Asepsis of the skin, washing with chlorhexidine soap and non-sterile gloves, change of gloves, disinfection with alcoholic chlorhexidine (handwashing between the two sequences)
6. Placement of cap and surgical mask and handwashing
7. Preparation of the sterile field
8. Handwashing
9. Gloves and sterile gown
10. Apply the tourniquet<\/p>\n\n\n\n <\/h4>\n\n\n\n
Placement:<\/span><\/h4>\n\n\n\n
2. Cleaning of the venipuncture site
3. Connection of the bioconnector, flushing with 10 ml of saline solution using the push-pause-push technique and positive pressure
4. Locking with saline solution or citrate depending on the protocol of the service with a volume equivalent to 120% of the dead space (internal volume) of the catheter
5. Catheter fixation with an adhesive or subcutaneous anchoring system
6. Locking of the insertion point with tissue adhesive
7. Transparent sterile dressing
8. Record procedure<\/p>\n\n\n\nMidline catheter maintenance<\/h2>\n\n\n\n
1. Change dressing and needle-free connector
2. Check position, reflux, catheter status and insertion point
3. Flush with 10 ml of saline solution (push-pause technique with positive pressure)
4. Lock with saline solution or citrate according to the protocol of the institution (with the same technique as above)
5. Record the procedure in the computerised clinical history.<\/p>\n\n\n\nMidline catheter removal<\/h2>\n\n\n\n
\u2022 Infection
\u2022 Irreversible obstruction
\u2022 Mechanical injury
\u2022 Venous thrombosis with malfunction
\u2022 Malfunction due to fibrin sheath or other reasons<\/p>\n\n\n\n <\/h5>\n\n\n\n
BIBLIOGRAPHY<\/h2>\n\n\n\n
\n