How to care for a Midline Catheter

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1 How to care for a Midline Catheter Developed by the health care professionals of the IV Program with assistance from the Department of Learning and Development. All rights reserved. No part of this book may be reproduced or transmitted in any form or by any means now known to be invented, electronic or mechanical, including photocopying, recording, or by any information storage or retrieval system without written permission from the authors or publisher, except for brief inclusion of quotations in a review. PE# 378 May Oak Street, Vancouver B.C, V6H 3N1,

2 Editor s note: I will use pronouns such as he and she alternately. When you read the brochure, please correct the pronouns for your child. Your healthcare team has decided that your child could benefit from a midline catheter for longer term intravenous (IV) therapy. IV therapy is a way to provide your child with nutrients, fluids and medications. A midline catheter can remain in place for 4-6 weeks. It can be used both in the hospital and at home. By placing a midline catheter in your child s arm, she will not have to go through the discomfort of having to start an IV whenever she needs medications. This means less needle pokes for your child. What is a Midline Catheter? A midline catheter is a thin tube that is inserted into the large vein in the elbow area of your child s arm. The catheter is up to 20 cm (8 inches) in length and the tip of the catheter sits in the upper arm (armpit) area. The tube is made of flexible material so that your child can move his arm freely. 1

3 How to Care for a Midline Catheter Special clear tape will hold the midline catheter in place. A white sticker shaped like a triangle will be in place under the clear tape. This is called a stat lock. The stat lock has two prongs that the midline catheter attaches to and helps to hold the midline in place. Things to Watch For 1. Irritation of the Vein It is normal for your child to have some discomfort in the arm for a day or two after the midline catheter is placed. Look for the following signs: Redness, pain, swelling or warmth along your child s arm Pain when medicine is added into the midline catheter A lumpy or cord-like feeling or hardening along the vein where the midline catheter was place If you notice these signs, here are some things that you can do to make your child more comfortable: Apply warm compresses (a warm clean cloth wrapped in a plastic bag works well or a heating pad) to the upper arm for the first 2-3 days and every time you add medicine. If this doesn t help and your child continues to have pain, contact the community health nurse or BC Children s Hospital. If the vein is still hard after you apply a warm cloth, contact the community health nurse or BC Children s Hospital. Ask your child to use his arm normally and not to keep it stiff. Check upper arm circumference (measurement around the upper arm) daily in order to assess for swelling. Make sure that you measure in the same place everyday. 2 3

4 2. Dressing lifting off A little bit of bleeding at the area where the midline catheter enters the skin is normal for the first 1-2 days. The dressing will need to be changed after the initial bleeding and every week or when wet or dirty by your nurse. This picture shows what normal bleeding looks like after a midline catheter is inserted. Make sure that the dressing is clean and kept dry, you will need to cover the dressing for bathing a plastic bag held in place with waterproof tape works well. If the dressing is lifting off, place a new dressing overtop of the one that is lifting off. Your nurse will show you how to do this. Have your child avoid strenuous activities (jumping, lifting or active playing) for the first few days. Try some quiet activities like reading, doing puzzles or playing board games. No swimming or contact sports!!! 3. Blocked Catheter Sometimes the midline catheter can get blocked. It is a very small tube, so there are several reasons why it could become blocked. Here are signs that the midline catheter is blocked: The pump shows a high pressure reading. This will appear as HIP on the CADD pump or downstream occlusion, or medication will not flow. Do not allow anyone to aspirate blood back with a syringe, your midline is open ended and is not meant for blood sampling or for position check by aspiration. If blood aspiration is attempted it can create suction in the catheter like a vacuum cleaner hose on the curtain and can lead to blockage of the catheter. Increased resistance when flushing the catheter between medication doses can be a sign of blockage, or kinking of the catheter under the dressing. If this happens, do not use too much pressure. You will need to flush the Midline twice a day when medication is not running with heparin (a medication that prevents blood from clotting in the tube). A nurse will teach you how to do this. If you think that you have a blocked or kinked catheter, contact the community health nurse or BC Children s Hospital. 4 5

5 Important information needed about my child s Midline Catheter Have someone on your healthcare team fill in this information when your child has his midline catheter placed. Patient name: Diagnosis: Physician name: Midline inserted by: (name) Date inserted: Midline size: Length of catheter: Upper arm circumference: Weekly dressing change on: Medication dosage: Medication times: IV Pump used: Good Luck! Here are some tips to remember: Check your child s dressing around the midline catheter insertion often and change it if is dirty, wet or lifting off. Apply a warm compress if it is sore. Always wash your hands before caring for your child s midline catheter. Don t be afraid to call if you have questions or concerns. Important Phone Numbers BC Children s Hospital: (604) Home IV Program local: 7635 Paging: (604) Home IV Program Pager: (ask for this pager # when you call the BC Children s Hospital Paging Number) IV Therapy Team Pager: BC Children s Emergency: Medical Day Unit: (604) Community Health Nurse: 6 7

6 My questions: 8

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