50% of central lines are inappropriate. Approximately 20% cause morbidity and mortality from acute events, air emboli, and blood stream infections.
We’re struggling to find guidelines beyond these MAGIC Tables.
That most of us in Australia have never heard of let alone seen a midline gives an indication of where we’re up to with regards to intravenous access management overall.
We’re going to put it out there: perhaps all drugs (even TPN?) can be infused via a midline Many institutions outside Australia use midlines for vasopressor administration.
Perhaps it’s better to infuse dilute amiodarone through forearm cannulae with risk of thrombophlebitis, than endure the real but poorly documented risk of central/PICC line insertion. Read this review article on extravasation injuries in adults.
It’s difficult for us to make well informed decisions. Our ability to review venous access from decision to insert to removal and assessment of complications is poor. We need better means of auditing this vital information: see here. In the UK a large audit is currently underway (ICNAP-1): more info as we get it.
These MAGIC tables are a good start.