Midlines

Overview

• Length: 8-25 cm, inserted through upper arm veins, terminates at axilla.
  • Shorter ones last better than ultrasound guided peripheral IVs.
  • Longer ones can run pressors. and has less complications than central lines.
• Because they terminate at axilla, are peripheral access, not a central venous catheter.

Indications

• Unable to establish standard peripheral IV
• Concern for IV dislodging
• Longer term IV access

Contraindications

• Overlying skin infection
• Thrombosis of target vessel

Complications

• Arterial puncture
• One observational study of 403 ED patients showed no catheter-associated bloodstream infections

Usage

• Medications that cannot be run through midlines:
  • Chemotherapy
  • Total parenteral nutrition
• Length of use: typically 2-7 days, but institution dependent

See Also

Vascular access types

• Central venous catheterization
  • Central line: internal jugular
  • Central line: subclavian
  • Central line: supraclavicular
  • Central line: femoral
  • Pediatric central line
  • Sheath introducer
• Rapid infusion catheter
• Intraosseous access
• Venous cutdown
• Umbilical vein catheterization
• Ultrasound assisted peripheral line placement
• External jugular vein cannulation
• The "Easy IJ"
• Midlines

External Links

• Scott Weingart. EMCrit 262 – Midlines – Part 1. EMCrit Blog. Published on December 27, 2019. Accessed on December 28th 2019. Available at https://emcrit.org/emcrit/midlines-1/
• Short and extended videos of 20 cm midline placement
• emDOCs: Micropuncture Kits for Difficult Vascular Access