Your Physician will decide. Their decision is based on the type of IV therapy you are ordered, the length of time it is ordered for.

In a word, yes. Needles hurt. Whether it is a very small needle to inject saline or lidocaine; or the larger introducers for line insertion, needles hurt. We make every effort to minimize the discomfort while working within the scope of practice as RN’s as outlined by the State Board of Nursing.

A small amount of blood loss is expected with insertion of a PICC or Midline. Although it may look like a large amount, in most cases, it is less than the amount that is drawn for lab work in the doctor’s office. Occasionally, if the patient has extremely complex medical problems and/or vasculature, there may be more blood loss. That is the exception, not the rule.

As long as it is flushing well, and the site is free of infection, a midline may remain 6-8 weeks. A PICC may remain 1 year. As a comparison, peripheral IV catheters (less than 3 inches) need to be changed every 72 hours (3days).

We utilize gauze on the initial dressing to absorb slight oozing of blood that occurs during the first several hours after insertion. Otherwise, gauze should not be used. If it is used, the dressing should be changed every 24 hours.

PICC stands for Peripherally Inserted Central Catheters. They are synthetic catheters that are inserted peripherally (in an extremity, usually an arm) and extend into the large vein that is before the heart. The Registered Nurse inserting this is trained to measure how long the catheter needs to be inserted into each individual person. The majority of PICCs we place can now be cleared for immediate use by utilization of ‘Tip Location’ technology that has been FDA approved. Patients who are ineligible for ‘tip location’ will need traditional chest x-ray confirmation prior to use.

A PICC line insertion is an invasive procedure. The catheter (when properly placed) extends into the chest cavity approximately 2-3 inches before the heart. There are certain risks associated with the procedure. We highly recommend having these explained to you prior to the procedure.

Every 7 days with a bioclussive dressing. If the dressing becomes wet or the edges frayed, it should be changed at the time of finding. We recommend 72 hour dressing changes.

A midline is also an extended dwell catheter that, externally, looks very much like a PICC line. The largest difference between the two devices is that while a PICC ends in the large vein near the heart, a midline terminates in the extremity (arm). Although lengths vary in the PICC line, a midline usually comes premanufactured 20cm (8″) long. These do not require a chest x-ray and are ready for immediate use.

Two ways. Blind stick technique (traditional) and Ultrasound Guided. Once the vein is accessed successfully, a thin catheter is advanced through the sheath to the designated appropriate length. The sheath is removed and all that remains is the catheter.

Which type of device depends on what therapy is ordered and what type of device is ordered. As a general guideline, any therapy lasting longer than 5 days should be administered through a PICC or Midline. Highly irritating solutions/medications should be administered through a PICC line.

Ultrasound can be utilized for placing a midline or PICC line but is not necessary in all circumstances. Ultrasound is an excellent adjunct to traditional ‘blind stick’ placement. It is utilized when the inserter cannot palpate or visualize veins capable of being accessed; or when blind stick attempts are not successful. Ultrasound allows the trained inserter to visualize and access veins that are otherwise not seen or felt.

Most people have veins that are easily accessed by highly skilled RN IV Specialists. The ultrasound coupled with MST (modified seldinger technique or microstick technique) adds more discomfort and cost to traditional techniques.