• Midline catheter is a venous access device whose tip sits within an axillary vein
• most common veins used are cephalic or basilic vein
• Tip of midline catheter resides within the peripheral venous system
• does not advance into superior vena cava (SVC) or any central vein

• For short-term use to provide venous access
• <30 days, refer to manufacturer's instructions
• Depending on the type of midline catheter used, use for blood sampling

• Device-related infection, bacteria, or septicaemia is known/suspected
• Patient's body size insufficient to accommodate size of implanted device
• Patient is known/suspected to be allergic to materials contained in the device
• Local tissue factors and/or past treatment will prevent proper device stabilisation and/or access
• Planned drug infusion not compatible with peripheral administration

• Select whether using ultrasound guidance or palpation and visual guidance

Using PowerGlide Pro™ midline catheter

• BARD PowerGlide insertion set
• Skin prep: chlorhexidine gluconate 2% and isopropyl alcohol 70% cleaning solution
• if chlorhexidine sensitivity suspected, povidone-iodine 10% aqueous solution
• Topical anaesthetic cream or lidocaine 1% or 2% 10-mL ampoule
• Sterile gloves
• Tourniquet
• Flush solution: sodium chloride 0.9%
• 10 mL syringe
• If using ultrasound device, sterile ultrasound probe cover and sterile gel

Using Vygon leaderflex 22G line

• Vascular access pack
• Leaderflex midline catheter (22G 80 mm or 200 mm)
• Skin prep: chlorhexidine gluconate 2% and isopropyl alcohol 70% cleaning solution
• if chlorhexidine sensitivity suspected, povidone-iodine 10% aqueous solution
• Sterile gloves
• Tourniquet
• Flush solution: sodium chloride 0.9% (10 mL)
• 10-mL syringe
• Needle free connection device
• Sterile semi-permeable transparent dressing (Tegaderm^®)
• If using ultrasound device, sterile ultrasound probe cover and sterile gel

Local anaesthetic

If clinically indicated that patient requires local anaesthetic

• Topical anaesthetic cream OR
• Lidocaine hydrochloride 1% or 2% 10-mL ampoule
• 1 × 22G orange needle
• 5 mL syringe
• 1 drawing up blunt needle

• If not competent in procedure, organise supervision by a clinician experienced in the procedure

Preparation

• Check patient's notes for
• clinical indication for line insertion
• previous line insertions. Some veins can be particularly difficult and patient can often provide guidance
• Assess whether patient will need sedation and arrange appropriate person to administer
• rarely, patients with needle phobia will need general anaesthetic
• Apply topical anaesthetic cream around specified veins at 3 different sites at least 20 min before starting procedure or if using lidocaine hydrochloride, 1% or 2% infiltrated over the insertion site
• median basilic vein is usually best (avoid femoral if possible due to higher infection risk)
• If necessary, shave patient's arm to avoid hair plucking when dressing removed
• Gather all necessary equipment including a spare line (unopened)

Consent

• Explain procedure and reassure patient
• Obtain verbal consent and document it in patient's notes

Premedication and position of patient

• Position patient seated in chair or lying with his/her arm stretched out on utility drape supported by table or bed
• Ensure patient in position and comfortable, and lighting optimal

Sterile technique

• Wash hands, and put on sterile gloves
• Place patient's arm on a sterile drape
• Clean patient's skin thoroughly in area of planned insertion for at 30 seconds and allow to dry for 30 seconds with:
• chlorhexidine gluconate 2% and isopropyl alcohol 70% cleaning solution
• if chlorhexidine sensitivity suspected, povidone-iodine 10% aqueous solution
• Drape patient's arm with fenestrated drape over insertion site sterile sheet to expose only chosen vein
• cover surrounding areas to provide working room and a flat surface on which to rest line

BARD PowerGlide Pro

• Ask assistant to apply tourniquet
• Image vein using ultrasound device or visualise and palpate vein
• Use the integrated BARD placement device to:
• cannulate vein
• advance integrated guidewire
• deploy midline catheter (Seldinger technique)
• Remove deployment device
• Flush midline catheter with sodium chloride 0.9% 10-mL using a push-pause technique
• Apply BARD's fixation device to midline
• Cover site with a Biopatch Dressing^®
• It is not necessary to verify position of midline radiologically

Vygon Leaderflex lines

• Ask assistant to apply tourniquet
• Image vein using ultrasound device or visualise and palpate vein
• Insert using Seldinger technique
• Cannulate target vein with either needle provided or blue cannula
• Feed guidewire into vein through cannula sheath and remove sheath leaving wire in situ
• Feed line over guidewire but before line enters skin ensure wire can be grasped at hub
• a gentle twisting action may help line into vein
• Remove guidewire and secure line in place
• It is not necessary to verify position of midline radiologically

• Use an ANTT technique when accessing the system or for dressing changes
• Document insertion and all interventions in patient notes

If using a Vygon midline

• Place a folded half gauze swab under blue hub before taping down with adhesive
• Cover with transparent dressing
• minimise contact between gauze and transparent dressing in case removal is required for troubleshooting

BARD and Vygon midlines

• Flush after each use with sodium chloride 0.9% 10-mL with a 10 mL syringe or bigger
• using a pulsed, push-pause technique
• Change dressings and needle free connection every 7 days
• sooner if visibly soiled or coming away
• Maintain aseptic technique for accessing system and dressing changes
• before accessing system, disinfect hub and ports with disinfectant compatible with catheter (e.g. alcohol or povidone-iodine)
• Assess site at least daily for any signs of infection
• if signs of infection are present, remove line
• Assess need for device daily and remove as soon as possible