Patient education: Midline IV catheter insertion (The Basics)

What is a midline IV catheter? — A midline IV catheter, or "midline IV," is a special kind of IV (figure 1).

You might need a midline IV if you:

●Need to get medicines or fluids for a few days or weeks

●Are taking medicines that need to be given through an IV, and the veins in your arm are very hard to find

●Need frequent blood tests

With a midline IV, you can get the fluids and medicines you need directly into your body. You might also need fewer needle sticks for IVs or blood tests.

How is a midline IV different from other IVs? — There are different types of IVs. They all use a thin, flexible tube, or "catheter," that goes into a vein. But they have some differences:

●Simple IV – This type only goes a little way into a smaller vein. Most simple IVs last only for a few days.

●Midline IV – This type goes into a larger vein above the elbow. When the doctor or nurse puts it in, they move it forward until the end is just below the armpit. A midline IV can stay in place for a few days or weeks.

●Peripherally inserted central catheter, or "PICC" – This type is longer than a midline IV. It goes much farther into a blood vessel, and the tip is much closer to the heart. A PICC is a kind of "central venous catheter."

A midline IV can have 1 or 2 ends called "lumens" or "hubs." These stay outside of the body and are covered with caps. You can go home from the hospital with a midline IV.

How do I prepare for a midline IV? — The doctor or nurse will tell you if you need to do anything special to prepare. Before your procedure, your doctor will do an exam. Ask the doctor or nurse if you have questions or if there is anything you do not understand.

Your doctor will also ask you about your "health history." This involves asking you questions about any health problems you have or had in the past, past surgeries, and any medicines you take. Tell them about:

●Any medicines you are taking – This includes any prescription or "over-the-counter" medicines you use, plus any herbal supplements you take. It helps to write down and bring a list of any medicines you take or bring a bag with all of your medicines with you.

●Any allergies you have

●Any bleeding problems you have – Certain medicines, including some herbs and supplements, can increase the risk of bleeding. Some health conditions also increase this risk.

●If you are not able to have medicines that make you numb – These types of medicines are used when you have stitches or dental work (sample brand names: Lidocaine, Xylocaine, Novocain).

You will also get information about:

●Fasting – This means not eating or drinking anything for a period of time. Whether you need to fast, and for how long, depends on if you will need medicines to help you relax during the procedure.

●Lowering the risk of infection – Sometimes, the doctor or nurse might need to trim (not shave) your body hair before your procedure. They might also have you wash the area with a special soap.

●What help you will need when you go home – For example, you might need to have someone else bring you home or help you care for your midline IV at home.

What happens during a midline IV placement? — When it is time for the procedure:

●You might be in your hospital room or in a treatment room. The doctor or nurse might give you medicine to help you relax.

●You will lay your arm on a table or pillow.

●The doctor or nurse will clean your arm with a special soap. They will also cover your arm and body with sterile towels and sheets. They will wear a face mask, hat, gown, and gloves to help prevent infection.

●The doctor or nurse might give you a local anesthetic. This is a medicine to numb the skin so you don't feel pain. Sometimes, they will use a numbing cream or spray on your arm where they will place the midline IV.

●They might use an ultrasound machine to guide the midline IV into your vein. An ultrasound is an imaging test that creates picture of the inside of the body. The doctor or nurse will put the catheter into a vein above your elbow and slide it into position. The tip will be just below your armpit.

●When the procedure is done, the doctor or nurse will "flush" the midline IV with a sterile fluid. Then, they will place a cap on each of the lumens.

●In some cases, doctors will place a:

•Small sponge disc that helps prevent infection

•Device to help hold the catheter in place

●Then, they will place a clear dressing over the area (figure 2).

●The procedure takes 20 to 40 minutes.

What happens after the midline IV is placed? — The doctor or nurse will make sure that the IV is in the right place before it is used. If you are in the hospital, having a midline IV will not make your stay longer. Some people can go home with a midline IV.

What are the risks of having a midline IV? — The doctor or nurse will talk to you about all of the possible risks and answer your questions. Possible risks include:

●Infection

●Irritation of the vein (called "phlebitis")

●Blood clot

●Bleeding

●The midline IV stops working, breaks, or leaks

●The midline IV moves out of place or falls out

What else should I know? — If you are going home with a midline IV, you might need a family member or friend to help you care for it. Some people have a home health nurse come to their home to help with this.

More on this topic

Patient education: How to care for a midline IV catheter (The Basics)