Infection, Prevention and Control - Midline Information

What is a Midline?

A Midline is a thin, flexible tube known as a catheter, inserted into a vein in the upper arm. The tip of the line sits in a vein in your armpit.

The space in the middle of the tube is called the lumen. Sometimes the tube has two lumens, this is known as a double lumen.

This allows different treatments to be given at the same time. At the end of the tube outside the body, each lumen has a special cap, to which a drip line or syringe can be attached. Sometimes there is a clamp to keep the tube closed when it is not in use.

Why do I need a Midline?

Your doctor has decided that you require fluid or drug treatment into your bloodstream for a longer period of time.

A Midline should mean you will only require one more needle to insert the line. The line can remain in place for between 4 weeks and 6 months depending on the manufacturer (the insertion team will advise on this). This usually means the line can last for the duration of your required therapy.

What are the alternatives?

The alternatives to having a Midline are as follows:

Repeated cannulae

If you continue to have your treatment through a cannula you will require this changing every 7 days or sooner if there are signs of irritation to the vein.

Who will insert my Midline?

A specially trained nurse, doctor or practitioner will discuss the Midline insertion procedure. They will talk to you about the benefits, alternatives, risks and problems. You will have the opportunity to ask any questions after the discussion and think about your options if you wish.

Line insertion will be completed either on the ward or in your home.

You can eat and drink normally before and after the procedure.

Who will care for my Midline?

While you are in hospital, the nurses will look after your Midline.

This involves cleaning the exit site, applying new dressings, changing bungs and flushing the line to prevent a blockage.

When you leave the hospital, your local community nurses may be contacted to care for your Midline at home.

How is the Midline inserted?

The procedure will usually be done with you lay on a bed; you will be lying down with your arm extended to the side.

The practitioner will clean the site, place sterile drapes around the area and inject local anaesthetic to numb the area where the line is to be inserted.

Next, an ultrasound machine is used to look for a suitable vein, a needle is inserted and the midline is thread into the vein. It will then be covered with a sterile dressing.

The dressing will be changed the next day then on a weekly basis. In addition, the dressing will be changed should it be visibly soiled.

The procedure is usually pain free, although some patients may feel pressure and minor discomfort.
 
You will not be able to feel the midline in the vein.

How long will it take?

It usually takes between 30-60 minutes to insert the line. This will allow enough time to explain the procedure, gather the equipment and insert the line.

Problems with the Midline insertion

Most Midline insertions go smoothly, but occasionally there are problems. Sometimes, the shape of the vein can prevent the Midline from being threaded upwards. If this happens, the practitioner will probably try again using a different vein.

Potential complications of a Midline

Many patients go through their treatment without having any problems with their Midlines, but there are certain risks involved. It is important for you to know what can go wrong so you can help prevent problems or deal with them if they happen. The practitioner putting in your Midline will spend time explaining this in detail.

Thrombosis (blood clot)

Having a Midline sitting in a vein does mean there is a risk of causing a blood clot. This sounds very alarming, but in fact if it does happen, it is very unlikely to cause a serious problem. If you have any pain, redness or swelling in your arm, this could be a sign a blood clot has formed. Patients who develop a clot due to their Midline are usually given medication and the line is usually removed 5 days later.

Infection

Infections caused by Midlines are uncommon. Great care is always taken when inserting the Midline and when cleaning and flushing the line. Even so, infections can happen at any stage.  Often infections can be treated with antibiotics, but we may need to remove your Midline to stop it from getting worse.

Damaged or split line

It is very important to prevent the Midline from getting damaged - for example, you should never use scissors near it! If the Midline splits or breaks, it will need to be removed.

Midline falling out or dislodged

A Midline falling out or dislodging from its original position is rare but if this happens please inform the team caring for you straight away.

If you are out of hospital and this happens:

• If your Midline has partially fallen out of place you should fix the line to your arm with tape or a plaster
• If your Midline completely falls out you should apply pressure to the insertion site if it is bleeding and cover it with a plaster

Things to look out for:

If you experience cold and shivery attacks during and after flushing your line or if you have a temperature above 38°C, it is very important that you tell a member of nursing/medical staff.

When your line is not being used, remember to check daily for:

• Redness
• Pain/discomfort
• Oozing (escape of fluid) from where the line comes out of your arm
• Hot to touch
• Swelling of your arm
• Leaking
• Damage to your Midline

If you have any of these problems, please make someone aware as soon as possible.

How should I care for my Midline?

Your Midline should not stop you from doing anything that you would usually do and you should carry out your daily routine as normal. However, once your Midline is in place it needs to be looked after carefully to prevent problems from occurring.

Please do not submerge the Midline in water or go swimming. Ask the ward staff for a plastic cover if you want to have a shower.

Before using your Midline, nursing and medical staff MUST:

• Wash their hands
• Put on gloves and an apron
• Clean the end of the line with a wipe for 15 seconds
• Allow this to dry completely before accessing the Midline
• Flush Midline with normal saline before and after using the line
• Remove gloves and apron
• Wash their hands

This is to protect you and other patients from any infections. Your Midline will always be covered by a dressing to protect it!

Do not peel the dressing away and always tell the nurse if the dressing becomes loose, dirty or wet.

The dressing will require changing once a week or sooner if it is visibly soiled and this will be done by a member of nursing staff.

Further Information

If you have any questions about Midlines please do not hesitate to ask your nurse or doctor