What is a midline catheter?

What is a midline catheter?

A midline catheter is a medium length piece of plastic tube that is inserted through a vein and sits near the armpit. It is used to give things like medication for longer than a week.

Introduction

A midline catheter is a medium length tube, about 5-8cm long, that is inserted into a vein in the upper arm, up to the armpit. It is used to give medication, usually antibiotics, when you need treatment for more than a week.

The midline catheter can be inserted while awake, in an operating theatre. Some people might prefer to have some sedation to help them relax, or to be asleep.

A specially trained doctor will inject some local anaesthetic around the insertion area to make sure it is numb, and you don’t feel any pain.

Your treating team will give you information about the procedure to insert the midline catheter and any preparation you need to do.

The midline catheter is always covered by a dressing to keep it clean and safe. It is also held in place using a securement device. You can also use a stretchy, tubular bandage, such as PICCsox to make it more comfortable.

The midline catheter is checked by a hospital in the home (HITH) nurse at every home visit and will be removed when treatment is finished.

How to care for your midline

You might be sent home from hospital with the midline catheter still inserted. You will need to make sure the midline catheter is well taken care of to avoid infection and keep it working properly.

Your doctor or nurse will give you instructions on how to take care of the midline catheter. You will also have check-ins with the hospital in the home (HITH) nurse to make sure everything is working properly.

The following tips can help you look after the midline catheter

Hygiene

  • wash hands carefully and wear gloves when changing the dressing and cleaning the skin around the midline catheter.

Showering

  • make sure the dressing is kept clean and dry at all times
  • for baths, make sure the midline catheter is kept out of the water to prevent infection
  • for showers, cover the midline catheter with plastic clingwrap and use tape at each end so it stays dry.

Dressing

  • check the dressing throughout each day to make sure it is secure and not peeling off
  • change the dressing every 7 days, carefully following the instructions given by your treatment team
    • changing the dressing can involve carefully removing the old dressing and cleaning the skin with antiseptic solution, before applying a new clean dressing.
  • note: your healthcare team will usually change the dressing for you. Please do not attempt to do this yourself without being given clear instruction to do so.

Checking the midline

  • check the midline catheter to make sure it is not kinked or bent
  • make sure the Needleless Access Device (NAD) on the end of the catheter stays connected at all times
  • be careful when getting dressed, making sure the midline catheter is not accidently removed or dislodged.

Avoiding damage

  • make sure that you do not play any contact sports to avoid damage to the midline catheter
  • do not allow anyone to touch the midline catheter.

When to seek help

The following information is about issues that can happen with a midline catheter at home, and what to do.

The midline is accidently removed 
  1. lie down and apply firm pressure over the site with cotton wool or a clean disposable towel for 5 minutes to stop the bleeding
  2. cover the site with a spare dressing
  3. contact your treatment team or HITH nurse.
The infusor is disconnected from the midline 
  1. clamp the midline, do not attempt to reconnect
  2. contact your treatment team or HITH nurse.
The midline breaks 
  1. stop any infusion
  2. using the clamp on the midline, clamp above the break closest to the skin where the midline has been inserted
  3. if you are unable to clamp the midline, bend the midline above the break and tape the midline firmly together
  4. cover with a gauze square or a clean disposable towel to keep clean
  5. secure the midline with a spare dressing
  6. contact your treatment team or HITH nurse.
The Needleless Access Device (NAD) has fallen off
  1. clamp the midline immediately
  2. if you are unable to clamp the midline, bend the midline above the break and tape the midline firmly together
  3. attach a new NAD to the end of the midline, DO NOT replace the old NAD back onto the midline
  4. If you do not have a spare NAD, wrap the end of the midline with the spare dressing and apply tape around this dressing and midline
  5. contact your treatment team or HITH nurse.
You develop a fever or signs of infection

Stop the infusor, clamp the midline, call your HITH nurse, and go to the nearest emergency department if you develop:

  • a fever
  • swelling, redness, or pain at the entry site
  • swelling, redness or pain up the arm.
The dressing is loose, wet or dirty
  1. do not remove the dressing
  2. secure the dressing with spare, clean dressing
  3. contact your treatment team or HITH nurse.
The midline appears longer or shorter
  1. secure the midline with spare dressing to prevent further movement
  2. contact your treatment team or HITH nurse.
There is leaking or drainage at the entry site
  1. stop the infusor and clamp the midline
  2. contact your treatment team or HITH nurse.
There is blood in the midline 
  1. stop the infusor and clamp the midline
  2. contact your treatment team or HITH nurse.

Midline management

Removal of the midline

You will have the midline catheter removed when treatment is finished, or it is not working like it should be. The midline catheter can be removed easily by a specially trained doctor or nurse. You will not need to go under general anaesthetic to have the midline catheter removed.

Flushing and Locking

Flushing is when a normal salt water or saline solution is pushed in the midline catheter by a syringe. This helps to stop it from becoming blocked and is done after medication has been given.

Locking is when an anti-blood clotting and antibacterial solution is left in the midline catheter when it is not being used. This is typically done when the midline catheter does not need to be used for up to one week and stops infection from happening and the line from becoming blocked.

Rare but serious complications

Because the midline catheter sits inside the body, there is a small risk that it could damage or puncture the wall of blood vessels. A serious infection or blood clot could also develop. These complications are extremely rare but can be life threatening.

Your doctor will talk to you about the midline catheter, the risks and the benefit before you have the procedure. Make sure you ask any questions you have about the midline catheter and caring for the line.

Disclaimer

This factsheet is provided for general information only. It does not constitute health advice and should not be used to diagnose or treat any health condition.

Please consult with your doctor or other health professional to make sure this information is right for you and/or your child.

The Sydney Children’s Hospitals Network does not accept responsibility for inaccuracies or omissions, the interpretation of the information, or for success or appropriateness of any treatment described in the factsheet.

 

© Sydney Children’s Hospitals Network 2024

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