Midline catheter

• PPE (minimal consideration disposable apron and gloves)
• Clean tray
• 10ml luer lock syringe
• IV 0.9% sodium chloride (NaCl) (appropriate volume for patient and VAD)
• 21g safety hypodermic needle or 18G blunt filter needle
• 2% chlorhexidine in 70% isopropyl alcohol wipe/wand (0.5% chlorhexidine in 70% isopropyl alcohol is recommended as an alternative for babies less than 3 months old)
• Clinical waste bag
• Sharps bin.

• Explain the process to the child and parent and gain consent.
• Perform hand hygiene.
• Decontaminate neck of ampoule with 2% chlorhexidine and 70% alcohol wipe and allow to dry. Using ANTT, draw up flush using 10ml syringe and hypodermic needle. Dispose of needle into sharps bin and protect tip of syringe by placing in Micro Critical Field (sterile syringe packet).
• Perform hand hygiene.
• Apply PPE.
• ‘Scrub the hub’ of the NFAD for at least 30 seconds using 2% chlorhexidine and 70% alcohol and allow to dry.
• Using ANTT, access midline via the NFAD using prepared syringe. Unclamp NFAD and flush the midline using a turbulent push/pause technique, clamp NFAD whilst maintaining positive pressure.
• The flush should be administered with ease. If there are signs of resistance, infiltration, extravasation or inflammation discontinue flushing process and consider replacing the midline.
• Discard all disposable equipment.
• Remove PPE and discard as healthcare waste.
• Perform hand hygiene.

Record procedure and complete PVC bundle.

• PPE (minimal consideration disposable apron and gloves)
• Clean tray
• 2% chlorhexidine in 70% isopropyl alcohol wipe/wand (0.5% chlorhexidine in 70% isopropyl alcohol is recommended as an alternative for babies less than 3 months old)
• Appropriate sterile semi permeable transparent dressing
• Medical adhesive remover (if required)
• Sterile swab for culture (only if signs of infection)
• Clinical waste bag.

As required if dressing is visibly loose or soiled.

Every 7 days if it is clinically indicated that midline is required to remain in situ and no signs of phlebitis or infection.

• Explain the process to the child and parent and gain consent.
• Perform hand hygiene.
• Apply PPE.
• Loosen and carefully remove the old dressing in an upward direction towards the puncture site, taking care not to pull or dislodge the midline. Medical adhesive remover can be used here to aid in the removal of the dressing.
• Inspect exit site and surrounding skin for signs of phlebitis or infection. Swab area if required.
• Replace gloves if heavily contaminated with body fluids.
• Using ANTT, hold the catheter and cleanse area, starting at the entry site, using 2% chlorhexidine and 70% isopropyl alcohol in a ‘circular’ pattern, starting at the puncture site and allow to dry for at least 30 seconds.
• Apply sterile dressing ensuring adherence.
• Discard all disposable equipment.
• Remove PPE and discard as healthcare waste.
• Perform hand hygiene.

Record procedure and complete PVC bundle.

Ensure VAD is positioned correctly to ensure skin health is maintained.

• PPE (minimal consideration disposable apron and gloves)
• Clean tray
• 2% chlorhexidine in 70% isopropyl alcohol wipe/wand (0.5% chlorhexidine in 70% isopropyl alcohol is recommended as an alternative for babies less than 3 months old)
• Appropriate sterile semi permeable transparent dressing
• NFAD (x1 per lumen)
• 10ml luer lock syringe
• IV 0.9% sodium chloride (NaCl) (appropriate volume for patient and VAD)
• X2 21g safety hypodermic needle or 18G blunt filter needle
• Medical adhesive remover (if required)
• Sterile swab for culture (only if signs of infection)
• Clinical waste bag
• Sharps bin.

If dressing is visibly loose or soiled.

• Explain the process to the child and parent and gain consent.
• Perform hand hygiene.
• Decontaminate neck of ampoule with 2% chlorhexidine and 70% alcohol wipe and allow to dry.  Using ANTT, draw up flush using 10ml syringe and hypodermic needle. Prime NFAD. Dispose of needle into sharps bin and protect tip of syringe by placing in Micro Critical Field (sterile syringe packet).
• Perform hand hygiene.
• Apply PPE.
• Ensure midline is clamped prior to commencing next steps.
• Loosen and carefully remove the old dressing in an upward direction towards the puncture site, taking care not to pull or dislodge the midline. Medical adhesive remover can be used here to aid in the removal of the dressing.
• Inspect exit site and surrounding skin for signs of phlebitis or infection. Swab area if required.
• Replace gloves if heavily contaminated with body fluids.
• Using ANTT, hold the catheter and cleanse area, starting at the entry site, using 2% chlorhexidine and 70% isopropyl alcohol in a ‘circular’ pattern, starting at the puncture site and allow to dry for at least 30 seconds.
• Using ANTT, ‘scrub the hub’ threads with the 2% chlorhexidine in 70% isopropyl alcohol wipe for 30 seconds. Allow to dry. Remove NFAD and apply primed NFAD.
• Apply semi permeable dressing to site ensuring that the catheter is covered with the dressing and good adherence to the skin.
• Using ANTT, attach 10ml syringe filled with 0.9% sodium chloride, flush the midline using a turbulent push/pause technique, clamp NFAD whilst maintaining positive pressure. Detach syringe.
• If there are signs of resistance, infiltration, extravasation or inflammation discontinue flushing process and consider replacing the midline.
• Discard all disposable equipment.
• Remove PPE and discard as healthcare waste.
• Perform hand hygiene

Record procedure and complete PVC bundle.

• PPE (minimal consideration disposable apron and gloves)
• Clean tray
• Sterile gauze swabs
• Sterile adhesive dressing (check allergies)
• Medical adhesive remover (if required)
• Clinical waste bag.

• Explain the process to the child and parent and gain consent.
• Perform hand hygiene.
• Stop all fluids being infused via the midline and disconnect administration set (if applicable).
• Perform hand hygiene.
• Apply PPE.
• Loosen and carefully remove the midline dressing in an upward direction. Medical adhesive remover can be used here to aid in the removal of the dressing.
• Hold a piece of sterile, dry cotton gauze over the insertion site and remove the midline.
• Apply firm pressure immediately to insertion site for approximately 2-3 minutes or long enough to ensure that there is no bleeding.
• After removal, the midline should be inspected for integrity, length and damage.
• Apply a sterile adhesive dressing to the insertion site, checking for any allergies.
• Discard all disposable equipment.
• Remove PPE and discard as healthcare waste.
• Perform hand hygiene.

Record procedure and complete PVC bundle.