Do you order a CXR for Midline placement?

75 yo man with persistent bacteremia due to diverticulosis is discharged home with HIVAT (home IV antibiotics) for 2 weeks. A Midline is placed.

Do you order a CXR for Midline placement?
Usually not.

There are differences between PICC line and Midline.

PICC lines enter a large central vein and a CXR is mandatory before the line is used to make sure that there is no pneumothorax and the line is in the correct place - in the distal portion of superior vena cava. PICC line can stay in place up to one year.

The midline is a 7-inch catheter (shorter than PICC) inserted in the antecubital region with the tip located in the axillary region. Thus CXR is usually not needed. Midlines can be used up to 4 weeks and that is why this catheter was chosen for the 2-week HIVAT course of this particular patient.

Midlines are sometimes called halfway catheters because they end halfway to the superior vena cava. Midlines are not suitable for total parenteral nutrition or chemotherapy.

CXR of PICC line:

Correct postion of PICC line. CXR report: There is a right PICC line with its tip in the distal portion of the superior vena cava. There is poor inflation of the lungs with elevation of the left hemidiaphragm. There is tortuosity and minimal dilatation of the thoracic aorta.

The bottom line: Midline is a shorter line with a shorter life span (up to 4 weeks) as compared to PICC.

Read more about other venous catheters - Different Venous Catheters - What is PICC, Hickman, Quinton, and Port-A-Cath?

New peripherally inserted midline catheter: a better alternative for intravenous antibiotic therapy in patients with cystic fibrosis. Pediatr Pulmonol. 1992 Apr;12(4):233-9.

Adverse Reactions Associated with Midline Catheters -- United States, 1992-1995 - CDC

PICC - Anatomy and Placement -

MidLine -

PICC and Midlines -

1 comment:

  1. Can someone tell me the evidence why we are not using Midlines for chemotherapy? Was there any clinical trial or any experiment of any kind to support that decision? Please help, Thanks.