Midline venous catheters - infants

What is a Midline Venous Catheter?

A midline venous catheter is a type of medical device used to provide central access for long-term intravenous (IV) therapy. It is a short-term, semi-permanent catheter that helps patients receive medications and fluids infused directly into a large vein, typically located between the shoulder and elbow of the arm on the same side of the body as the insertion point. Midline catheters offer the advantages of longer dwell times and less need for frequent renewals compared with traditional short peripheral catheterization.

Preparation for Midline Catheter Placement

Before a midline catheter is placed, the medical team will need to prepare the patient. This preparation includes the following steps:

• Training for the medical team to understand how to place the catheter correctly
• Skin prepping with Chlorhexidine Gluconate (CHG) to reduce the risk of infection
• Sterile surgical field setup
• Patient education to ensure informed consent
• Selection of appropriate vein

Procedure

The midline catheter is usually inserted with an ultrasound-guided technique to confirm correct placement. The catheter is then connected to an IV or other device. The following steps are typically involved in the insertion procedure:

• Patient positioning
• Venipuncture for catheter insertion
• Insertion of guidewire
• Advancement of catheter
• Removal of guidewire and sutures
• Final position and securement of catheter

Types of Midline Catheters

There are several different types of midline catheters available, depending on the length and size of the catheter and what type of IV solution is to be administered. The two most common types of midline catheters are:

• RMC Midline Catheter- This type of midline catheter is a single-lumen catheter with a 40 cm length and is used to deliver up to 1.0 L/H of IV solution at a rate of 600 mL/hr. It is typically used for short-term infusions and is not recommended for lipids.
• VMC Midline Catheter- This type of midline catheter is a dual-lumen catheter with a length of 50 cm. It is used for infusions of up to 1.5 L/H at a rate of 1200 mL/hr and is intended for long-term use. It is also suitable for lipids or other solutions with large molecular weights.

Risks of Midline Catheter Placement in Infants

Since infants have smaller veins than adults, the risks of complications due to midline catheter placement in infants are generally higher. These complications may include infection or thrombosis (blood clot). It is important to follow all recommended steps of prepping, insertion, and care to reduce the risk of these and other complications.

Why Midline Venous Catheters might be Used in Infants?

Midline catheters may be used in infants for a variety of reasons, including continuous delivery of medications or fluids, to avoid frequent IV needles, to reduce discomfort and stress for infants, and to reduce the risk of needle-stick injuries for caregivers.

When a Midline Venous Catheter is Appropriate for Infants?

Midline catheters may be appropriate for infants in certain situations, such as when the infant requires medication or fluid infusions on a regular basis over an extended period of time. When midline catheters are used in infants, it is important that they are closely monitored and managed by a healthcare team.