Implementation of a midline catheter service in a regional setting
Introduction: Midline catheters have been reported to be an effective and safe means of providing patients with intravenous access within the hospital and community setting. With minimal experience in the introduction of a midline service across the local health network, a regional hospital pursued this task. This observational study assesses the provision of a safe clinical framework for midline insertion, and the improvement of patient care and experiences by avoiding treatment interruptions and unnecessary cannulation attempts from failed traditional peripheral vascular access devices.
Methods: From the introduction of the midline service in June 2018, outcome measures of all patients who received a midline over the following two-year period were documented including rate of line success, complication rates, dwell time, and the number of insertion attempts.
Results: The midline service provided 207 lines over a two-year period with a total dwell time of 1,585 days. Project goals were achieved with 85% (Aim > 85%) of all lines completing treatment prior to removal. First attempt insertion was 86% (Aim > 80%) with a maximum insertion attempt of two. Rates of line-related complications were less than 8%, with five documented cases of phlebitis (2.5%) and one deep vein thrombosis with no infections documented.
Conclusion: Despite limited resources, a successful midline service was introduced. Future expansion will see an increase in insertor numbers providing improved access to the service.
Providing a single intravenous access for the course of a patient’s admission is a challenging and difficult task. For a large cohort of patients, numerous unsuccessful attempts precede achieving intravenous access (Sabri et al, 2013). Insufficient access to skilled and qualified vascular access specialists means unsuccessful attempts are often repeated throughout a single admission, particularly when prolonged access is required. These costly interruptions to treatment have the potential to lengthen hospital admissions and greatly impact patient and staff satisfaction with a higher risk of vascular access complications, such as infection, phlebitis, and pain (Anderson, 2004; Tagalakis et al, 2002; Uslusoy and Mete, 2008).
The introduction of midlines has provided vascular access teams with a safe, efficient and reliable means of establishing access in a population where central access is not indicated and traditional peripheral intravenous cannulation (PIVC) is difficult to establish, unreliable, or will require multiple insertions to achieve treatment goals (Anderson, 2004; Alexandrou et al, 2011; Moreau et al, 2015; Cummings et al, 2011). Midlines are recognized as an option to reduce the incidence of phlebitis, a substantial contributor to PIVC failure, and catheter-associated blood stream infections (Anderson, 2004; O’Grady et al, 2011; Warrington et al, 2012; Salgueiro-Oliveira et al, 2013).
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