HHC Health & Home Care Clinical Policy And

HHC HEALTH & HOME CARE Section: 9-8
Infusion Therapy: Midline Catheter Insertion __RN
3. Wash hands and assemble all equipment on a
sterile field where it is within easy reach for you.
Don mask and gloves, put on protective eye-wear if
indicated. Assist patient with wearing mask if
needed.
4. Place patient in comfortable reclining position,
making sure that site is accessible.
5. Ensure adequate lighting.
6. Wash insertion site with anti-infective soap and
water
7. Flush catheter with preservative-free 0.9% sodium
chloride, injection, to confirm catheter patency prior
to insertion.
8. Remove excess hair from intended insertion site
with clippers or scissors, if needed.
9. Fully extend patient’s arm.
10. Abduct arm in a 45 degree angle.
11. Disinfect insertion site using a single-dose antiseptic
solution. Recommended solutions include: a. 2%
chlorhexidine, b. 10% povidone-iodine, c. alcohol if
patient is allergic to iodine. Follow agency
guidelines for site disinfection procedure per
solution used. Remove and discard gloves.
12. Once site has been disinfected allow it to air dry, do
not blot, fan, or blow dry.
13. Apply tourniquet.
14. Don second pair of sterile gloves.
15. Drape arm with sterile towels or drapes to create a
sterile field.
16. 16. Venipuncture site should be 1- 1 ½ inches
above or below antecubital fossa.
7. Stabilize vein below intended access site with
nondominant hand.
8. Perform venipuncture using shallow angle (15
degrees – 30 degrees).
9. Remove tourniquet.
10. Stabilize introducer, withdraw stylet and remove
from sterile field.
11. Slowly advance catheter along vein pathway to the
desired length.
12. (If resistance is met then stop immediately and: a)
have the patient move the arm to a different angle
b) ask the patient to open and close his/her fist .
After these two have been done attempt to advance
the catheter again. If the catheter still cannot be
advanced stop the procedure. A second attempt
with a new catheter can be made with the patient’s
agreement.)
13. Once advancement is completed aspirate for blood
return to confirm patency.
14. Remove the guide wire in a slow and steady
manner while at the same time stabilizing the
catheter at the site of insertion.
15. Flush catheter to maintain patency with 3-5 ml of
preservative-free 0.9% sodium chloride followed by
3-5 ml of 100u/ml Heparin as prescribed.
16. Using sterile skin closure strips, sterile tape or other
manufactured devices to stabilize catheter once it is
inplace, flushed and ready for use.
17. Attach any add-ons devices as needed, i.e.
extension sets, injection caps/connectors, making
sure to flush all add-ons before attaching and using.
166