Display Patient Information Leaflets

Date issued: October 2024
For review: October 2026
Ref: C-593/SF/Vascular/Your Midline
PDF: Your Midline final October 2024.pdf [pdf] 282KB

Introduction

This booklet aims to provide support information about your Midline procedure and how to care for it once it has been inserted.

What is a Midline?

A Midline is a long, hollow, flexible tube that is inserted into one of the large veins in your arm. Midlines are usually inserted into a vein just above the bend of your elbow and the tip sits just below your armpit.

Midlines can stay in place for the duration of your planned treatment and do not routinely require replacement.

They can be single or double lumen.

Why do I need a Midline?

Your medical team will have recommended that you have a Midline inserted as part of the care you are receiving.

This type of device is recommended for patients who have a prolonged course of intravenous treatment. This makes it possible for you to have treatment without having needles frequently inserted into your veins.

You can go home with a Midline and carry on your treatment.

What are the benefits of a Midline?

A Midline can make treatment more comfortable for you by:

• Allowing you to have the medication given directly into your veins

• Reducing the irritation that certain drugs can cause to smaller veins

• Preventing the need for multiple needle punctures

• Preserving the long-term health of your veins

How do I prepare for the procedure?

As a patient you need to do very little to prepare for the insertion of the Midline.

When you arrive your doctor or nurse will discuss with you the insertion procedure, alternatives and potential problems. You will be offered an opportunity to discuss any issues and ask any questions with the clinician performing the procedure. You will normally be asked to provide consent for this procedure. Please inform your doctor or nurse of any allergies that you may have. You can eat and drink as normal.

Screening for MRSA and MSSA will be required for all patients prior to line insertion, this will be arranged by your medical team in the days leading up to your procedure. You may be asked to use a special body wash prior to your procedure depending upon the results of these tests.

What happens when I have the Midline inserted?

An outpatient appointment at the hospital will be offered to you for the Midline insertion. Your Midline will be inserted in a procedure room. It is not an operation but the clinician inserting your Midline will treat it as a sterile procedure. They will use an ultrasound scanner to be able to find the best vein for the insertion. They will wear a gown and sterile gloves and will use sterile equipment. Your skin will be cleaned with an antiseptic, after which a sterile drape will be placed over your arm. A local anaesthetic is used to numb a small area of your skin before the Midline is inserted.

The Midline will be held securely in place by a fixation device and a waterproof dressing.

You can go home if you have an outpatient appointment, and your Midline is ready to be used.

If you have any concerns or questions, please ask the Vascular Access Team. They will help you to clarify your concerns or questions.

Potential risks

Insertion:

It can sometimes be difficult to find a suitable vein or to get the Midline into the correct position. If this is the case, we may have to insert the Midline into a different vein or discuss alternative options with you.

Infection through the skin:

It is possible for an infection to develop inside or around the place where the Midline goes into the vein (this is called the insertion site). Contact your healthcare team immediately if you experience any of the following symptoms: pain, redness or swelling at the insertion site, discolored fluid coming out from the insertion site, a fever or chills.

Local bruising or bleeding in the insertion site:

It is common to experience some bruising or bleeding at the insertion site. Please inform us of any blood thinning medication you are taking before we insert the Midline, as this can increase your risk of bleeding (you do not usually have to stop taking this medicine before your procedure, your medical team will advise).

Vein inflammation (phlebitis):

Occasionally, the Midline may irritate the vein wall, which can cause pain and redness along the length of the vein. If this occurs, use a warm compress to encourage good blood flow around the Midline. If you have any concerns, please contact your healthcare team.

Dislodged line:

Review your Midline regularly. If the external part of the line appears longer or different in any way, please contact your healthcare team.

Break or split in the line:

it is important that the Midline is not broken or cut. Do not use scissors near your Midline. It is rare for a Midline to break or split, but if it does happen, contact your healthcare team immediately. The line may need to be removed and replaced.

Blood clots (thrombosis):

It is possible for a blood clot to develop around the Midline. If this occurs you may be given medication to dissolve the clot, and your line may need to be removed. Contact your healthcare team immediately if you experience any of the following symptoms: pain, swelling, discomfort or redness on the side of the insertion site.

Can I bathe or shower?

You can bathe or shower with a Midline in place. We ask that you try not to soak the dressing. The Midline should be covered with a waterproof covering such as clingfilm or a Limbo cover when taking a shower or bath (do not submerge the Midline). If the dressing is loose after your bath/shower, it should be replaced. If this happens you should contact the team responsible for your care.
You can get a sleeve cover either by buying one yourself or getting a prescription from your GP.

Can I use the arm where the Midline has been inserted?

The arm with the Midline can be used as normal; this will increase blood circulation in that arm which helps medication to spread throughout the body. However, strenuous work, lifting heavy objects or repetitive motion should all be avoided.
Never pull on the Midline.

Hand hygiene

You or any person caring for your Midline, should wash their hands and put on gloves prior to handling it.

Dressing changes

Your Midline will be checked by the team looking after you when it is used or at routine appointments. It will be checked for signs of bleeding and oozing. If the dressing is wet or soiled it should be changed immediately. The dressing will also be changed routinely every seven days, even if it appears clean and dry. If your dressing is wet or soiled and you are caring for your Midline you must change the dressing immediately.

When and how will my Midline be removed?

Midlines are usually removed at the end of treatment. Rarely, they are removed because of problems. The dressing will be taken off, skin cleaned with antiseptic, and the Midline will be pulled out, usually with no discomfort. Then a small dressing will be applied that you can remove after 72 hours.

Any problems?

If your Midline is being managed at home by either yourself or a community team, it is important that you contact the team that is caring for you to report any irregularities or complications such as swelling, redness, leakage or pain around the Midline insertion site. If the Midline has partly fallen out, fix it in place with some tape.

If the Midline has completely fallen out, cover the hole with either a sterile dressing or a clean towel for a few minutes and then apply a small sterile dressing. If it continues to bleed, carry on applying pressure. In all cases you must contact the team that is caring for you. You should then go to the Emergency Department immediately.

Contact details for advice

Derriford Hospital: 01752 202082