A midline catheter is a thin, flexible tube inserted into a peripheral vein in the upper arm, with its tip terminating below the armpit, but before the central veins. It is often used for infusions lasting longer than a typical IV can accommodate, usually for 1 to 4 weeks. Proper care is paramount to prevent infection and other complications, allowing for safe treatment at home.
Hand Hygiene: The Foundation of All Catheter Care
Thorough handwashing is the single most important step in preventing a catheter-related infection. This must be done meticulously before and after touching any part of the catheter or its dressing, and should be practiced by anyone assisting with your care.
The Correct Handwashing Procedure
To ensure proper hygiene, follow these steps:
- Wet your hands and wrists under running water.
- Lather with antibacterial soap, scrubbing for at least 20 seconds, making sure to clean between your fingers and under your nails.
- Rinse your hands with fingers pointing upward so the dirty water runs towards your elbows.
- Dry your hands with a clean, unused paper towel.
- Use the paper towel to turn off the faucet.
Sterile Dressing Changes
The dressing over your catheter site protects it from bacteria and should be changed weekly, or sooner if it becomes loose, wet, or soiled. Always use a sterile technique as instructed by your healthcare team.
Step-by-Step Dressing Change
- Gather supplies on a clean, flat surface. This may include a sterile dressing kit, antiseptic swabs (e.g., chlorhexidine), sterile gloves, and a mask.
- Wash your hands thoroughly and put on a mask.
- Carefully remove the old dressing, pulling it away from the catheter site. Hold the catheter securely to prevent it from moving.
- Inspect the site for any signs of infection, such as redness, swelling, or drainage, and dispose of the old dressing and gloves.
- Wash your hands again and put on a new pair of sterile gloves.
- Clean the catheter site with the antiseptic swab, starting at the insertion site and moving outward in circular motions. Let the area air dry completely without blowing on it.
- Clean the external catheter tubing with a new alcohol wipe, wiping away from the insertion site.
- Apply the new sterile dressing over the insertion site, ensuring all edges are sealed. The site should remain visible through the clear dressing.
- Secure the loose tubing to your skin with tape, away from the dressing, to prevent pulling.
Flushing Your Catheter
Flushing keeps the catheter clear and prevents blockages. Your healthcare provider will specify the frequency and type of solution (usually saline, sometimes followed by heparin).
Flushing Procedure
- Wash your hands thoroughly and prepare your supplies.
- Scrub the injection port vigorously with an alcohol wipe for at least 15-30 seconds, and allow it to air dry.
- Attach the prepared syringe and unclamp the line if necessary.
- Flush the catheter slowly using a push-pause method. Never force the flush; if you feel resistance, stop immediately and contact your provider.
- Clamp the line before the syringe is completely empty to prevent blood backflow, then remove the syringe.
Midline vs. PICC Line: A Comparison
While both are placed in the arm, midlines and peripherally inserted central catheters (PICCs) have key differences that affect their use and care. A midline is a peripheral line, while a PICC is a central line.
| Feature | Midline Catheter | PICC Line |
|---|---|---|
| Catheter Tip Location | Ends in a vein of the upper arm, near the axilla. | Ends in a large vein near the heart (superior vena cava). |
| Placement | Can often be done at the bedside by a trained nurse. | Requires a specially trained provider, often in a radiology suite. |
| Duration | Up to 4 weeks. | Weeks to months. |
| Infusion Type | Suitable for most IV fluids and many antibiotics. | Necessary for certain medications, long-term treatments, or TPN. |
| Risk Profile | Generally lower risk of serious complications like bloodstream infections. | Higher risk of infection due to central placement. |
Activities and Precautions
Proper protection and activity modifications are necessary to prevent damage or displacement of the catheter.
- Keep it dry: Avoid submerging the arm in water. Do not swim or use hot tubs. Use a waterproof cover and keep the arm away from direct spray while showering. Change the dressing immediately if it gets wet.
- Avoid damage: Never use sharp objects like scissors, razors, or pins near the catheter site. Avoid letting the tubing snag on objects or rub against clothing. Wear loose-fitting sleeves.
- Limit strain: Refrain from heavy lifting, contact sports, or vigorous, repetitive arm movements. Normal daily activities and light exercise are encouraged to prevent blood clots.
- Secure the line: Always ensure the catheter is secured to prevent accidental pulling. The dressing should keep it in place, but additional taping may be necessary.
Recognizing and Managing Complications
Monitoring for potential problems is an important part of midline catheter care. Report any issues to your healthcare provider immediately.
Signs of Infection
Look for these symptoms at the insertion site or systemically:
- Redness, swelling, tenderness, or warmth
- Pain or burning sensation
- Drainage or pus from the insertion site
- Fever or chills
Signs of Occlusion
An occlusion, or blockage, is a common complication.
- Inability to flush the catheter easily.
- Feeling pressure or resistance when flushing.
- Sluggish or slow flow during infusion.
Accidental Removal or Damage
If the catheter is pulled out or damaged, remain calm.
- Accidental removal: Apply firm pressure to the site with a clean gauze until bleeding stops. Call your provider immediately.
- Damage (e.g., crack or leak): Immediately clamp the line between the damaged area and your body. Call your provider.
For more information on proper vascular access care and infection prevention, consult a trusted resource like the American Cancer Society.
Conclusion
Caring for a midline catheter at home requires consistency and attention to detail. By following strict hygiene protocols, performing dressing changes and flushing as instructed, and protecting the line from damage, you can significantly reduce the risk of complications. Your healthcare team is your primary resource for all questions and concerns regarding your catheter care. Never hesitate to contact them if you notice any potential problems or have any doubts about your care routine.
