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Skill Summary

A midline catheter (MLC) is any percutaneously inserted IV line that is placed between the antecubital fossa and the head of the clavicle Figure 1. The concept of an MLC is similar to that of a peripherally inserted central catheter (PICC). It is advanced into larger vessels below the axilla (basilic, cephalic, and median cubital) where there is good hemodilution. Because it is inserted into the veins of the upper arm, rather than those of the central venous system, it may not (depending on agency policy) require an x-ray to verify tip placement. The optimal catheter tip location is level with the axilla, just distal to the shoulder and deltoid muscle.

The MLC is intended for intermediate-term therapy of 1–6 weeks for the delivery of nearly all infusion products, except chemically caustic materials and total parenteral nutrition (which require hemodilution in the superior vena cava). It is often used in the home care situation where around-the-clock nursing care is not available and where the client can self-administer medications.

The insertion and management protocols for an MLC follow the same principles and procedural guidelines as described for a PICC line. The arm must be assessed frequently and carefully as long as the catheter remains indwelling. Strict adherence to manufacturer’s recommendations for admixing, diluting, and administering infusates must be followed. Nursing and medical management of the major complications associated with MLC use are essentially the same as for PICC lines.

 

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