EMCrit 262 – Midlines – Part 1

Today on the podcast, we discuss Midlines. This is the first of two parts. In a week, I will interview Rory Spiegel on the topic, so send me your thoughts and questions in anticipation of that episode.

Our Article

* Utility of Midlines in Ann Emerg Med 2020

What the Heck is a Midline?

a 8-25 cm catheter that is placed in the arm and doesn't extend past the shoulder

Why Ultrasound-Guided IVs Suck?

* They aren't long enough [30021833]

* Nearly 1/2 of them are dislodged in 24 hrs [Ann Emerg Med 1999;34(6):711]

* Another study demonstrating they do not last [AJEM 2010;28:1]

* Vessel Depth and Catheter Depth are the key to longevity [AJEM 2011 Fields et al.]

* Need 2.75 cm in the vessel for good reliability [https://doi.org/10.1016/j.annemergmed.2019.11.013]

* Midlines are better for avoidance of infections

Which Midlines Do We Use?

10 cm Midline

Bard Powerglide ST

20 cm Midline

Medcomp 20 cm 5F CT Midline

I take no money from any of these folks

Video of the Dual-Lumen Midline Placement

Start at 7:10

Other Lit

Safety of Midlines for

Send Me ?s below or on Twitter

Now on to the Podcast...