VA Midline Insertion

A Midline is a type of catheter to administer medication and treatment. It is a long, flexible plastic tube that is inserted into one of the larger veins in the upper arm above the bend of the elbow and it ends at the level of the armpit. 

The end of midline is sealed with a needle free connector, which is replaced weekly to reduce the risk of infection. The needle-free connector can be attached to a drip or syringe containing your medication. The lumens are flushed regularly with saline to prevent them from becoming blocked. 

Part of the Midline tube remains outside of the skin, and usually this can be hidden by clothes so that people will not know that you have a line in place.  

To stop the line moving or coming out, it is attached to the skin on the arm using a securement device and covered with a sterile dressing, which is replaced weekly to reduce the risk of infection. 

The Midline can be used to give you medicines and treatments such as antibiotics, blood transfusions and intravenous (IV) fluids. It can also be used to take blood samples.  

The Midline can remain in place for up to 29 days. When it is not needed anymore it can be removed with a simple procedure. 

All treatments and procedures have risks and we will talk to you about the risks of having a Midline inserted. 

Problems that may happen straight away

Midline placement 

Occasionally it is not possible to place a Midline due to either lack of suitable arm veins or blockage of the vessels in the upper arm. In this situation, arrangements will be made for a different venous access device at another appointment. 

Problems that may happen later

Infection 

It is possible for an infection to develop inside the catheter or around where the Midline exits the skin. You should tell your medical team if you: 

• have redness, swelling or pain around the Midline 
• develop a temperature higher than 38°C (fever) 
• feel faint, shivery, breathless or dizzy. 

If an infection develops, you will be given antibiotics. If the infection does not get better, the Midline may need to be removed. 

Blood clots 

It is possible for a blood clot (thrombosis) to form in the vein where the Midline sits. You should contact your hospital doctor or nurse if you notice any:    

• swelling 
• tenderness 
• redness in the neck or arm on the same side of the body as the Midline. 

If a clot does form, you will be given medication to dissolve it. If the clot does not clear, the Midline may have to be removed. 

Inflammation of the vein (mechanical phlebitis) 

This is caused by the Midline irritating the vein and usually occurs soon after the line has been put in. Some patients experience pain and redness along the length of the vein in which the Midline sits. If this happens, the Midline may need to be removed. 

Blocked line 

The inside of the catheter can sometimes become partly or completely blocked. If this happens, it can be difficult to give treatment or to take blood tests through it. The Midline may be flushed with a solution to try to clear the blockage, or the Midline may need to be removed. 

Midline movement 

The tip of the catheter normally lies in the vein near the armpit but can occasionally move into a less favourable position.  

If the Midline is pulled on sharply or the dressing comes off, then all or some of the Midline may be pulled out of the arm. If there is minimal movement, it may be possible to continue using the Midline. 

To prevent the Midline coming out, it should always be covered with a dressing. If the dressing comes loose, it should be replaced as soon as possible. Do not push the Midline back into your arm if it has moved out as this could cause an infection. 

Air in the Midline 

It is very important not to get any air into your Midline. Our Midlines have clamps and needle free connectors at the end of the lumens to prevent air from entering the line. The clamps must always be closed when the line is not being used.  

Break or cut in the Midline 

It is important that the Midline is not cut or split. Do not use scissors near the Midline. It is not very common to get a cut or split in the line, but if this happens, the Midline will need to be removed.

This will depend on the type of treatment you are having. You should discuss your options with your doctor or nurse if you have any concerns. 

An alternative would be an intravenous (IV) cannula which is a very small, flexible tube, which is placed into one of your veins. One end sits inside your vein and the other end has a small valve that can connect to medications and treatments.  

A cannula generally only lasts for a few days. After this time, you will need a new one, which involves accessing another vein.

If possible, please try to drink plenty of fluids before your appointment as this will make it easier to put the Midline in.  

If you take tablets or injections to thin your blood, these may need to be stopped for a short time. This is to prevent any bleeding during the Midline insertion. Your doctor or nurse will explain this to you in detail.  

If you have ever had an infection called MRSA (methicillin-resistant staphylococcus aureus), please let your doctor or nurse know. You may need to have a nose swab to see if the infection is still present before your Midline can be put in.  

You need to attend the Imaging Department at the time instructed on your appointment letter. Please take all your medication on the morning of the procedure unless you have been informed to omit it by your doctor or the Imaging department.  

On arrival you will be checked into the department. The Vascular Access practitioner or assistant will collect you from reception. The Practitioner will explain the procedure and sign off the Consent form with you. This is where you will have the opportunity to address any concerns you may have.  

This procedure is performed under local anaesthetic.  

If you have any allergies, you must let your team know.

We want to involve you in all the decisions about your care and treatment. If you decide to go ahead with procedure, by law we must ask for your consent and will ask you to sign a Consent form. This confirms that you agree to have the procedure and understand what it involves.  

The consent form is a form that both you and the operating Practitioner sign confirming that you have discussed the procedure and been informed of the risks/benefits/alternatives and have agreed to carry on with the procedure. (You can have a copy of this form to take with you.) 

Please feel free to ask any questions that you may have and, remember that even at this stage, you can decide against going ahead with the procedure if you so wish. 

The procedure is performed under sterile conditions and the Practitioner will wear sterile gowns and gloves to carry out the procedure. The skin near the point of insertion, will be swabbed with antiseptic and you will be covered with sterile drapes.  

The Practitioner will use an ultrasound machine to locate a vein in your arm and decide where best to place the Midline. They will inject local anaesthetic into the skin to numb it. This will cause some temporary discomfort but once the skin is numb you won’t feel the Midline being threaded through your vein. 

You should not feel any pain but just a small amount of pressure. Please let the Practitioner know if you are uncomfortable. 

The Midline will be inserted into the vein through a tiny nick in the skin of the upper arm and threaded through the vein until it reaches the vein near the armpit. The Midline is held in place with a securement device, and a sterile dressing is applied to the area where the Midline exits the skin. 

We will aspirate (draw blood) and flush (clear the tube) of the Midline to check it is working. 

Occasionally there are difficulties in accessing a vein or threading the Midline into position. If this happens, your practitioner will probably try again using a different vein.

Your Midline will be secured to your arm using Statlock® and a sterile dressing. 

A Statlock® needs to be changed every seven days,  

at the same time as the dressing change.

Some discomfort may be felt in the skin and deeper tissues during the injection of the local anaesthetic. After this, the procedure should not be painful. There will be a nurse, or another member of clinical staff, standing nearby looking after you. If the procedure does become uncomfortable, please inform the staff member looking after you.  

Every patient’s situation is different, and it is not always easy to predict how complex or how straightforward the procedure will be. Generally, the procedure will be over in about 45 minutes.

You should be able to go home or back to the ward dependent on if you are an outpatient or inpatient. 

If needed, the line can be used straight after it has been put in.  

After the Midline has been inserted you can eat & drink as normal. You can go home or back to work. However, avoid strenuous exercise or heavy lifting for the remainder of the day,  

After that you may exercise or carry out most activities as normal. Sports such as tennis, golf, squash, or vigorous gym exercise are discouraged, as there is a risk that the Midline could be displaced because of excessive upper body movement. 

Take care that the Midline is secured before exercise, or it may become displaced. Sweating may lead to loosening of the dressing, or moisture forming around the Midline. If this occurs the dressing will need to be changed immediately. 

You will be able to use your arm normally while the Midline is in, but it is important that you keep the dressing dry. We will give you a special plastic sleeve to put on when you have a shower or a bath. Swimming is not recommended.  

Both the dressing over the Midline will need to be changed and the Midline flushed weekly. Flushing is a painless procedure where a syringe is attached to the Midline and fluid is flushed into it to stop it from getting blocked. If you are going home with your Midline in, your team may refer you to the district nurses for your Midline care.  

Some patients prefer their partner, a family member, or a close friend to care for their Midline. If this is something you would like, please discuss with your referring team.  

Things to look out for at home

While your Midline is in place, it is important that you contact your nursing or medical team, if you notice any of the following: 

• a high temperature (over 38°C)  
• feeling shivery 
• a sore or swollen arm  
• your Midline becoming displaced.  

If you have an infection, you will need to take a course of antibiotics and your Midline may need to be removed.

Once the Midline is no longer needed, it will be removed by one of the nurses on the ward or by the homecare company if treated by a district nurse. It is also possible to have it removed in the Vascular Access department. Removal of the Midline is a quick and painless procedure.  

Some of your questions should have been answered on this page but remember that this is only a starting point for discussion about your treatment with the doctors looking after you. Make sure you are satisfied that you have received enough information about the procedure.

Contact and references

British Society of Interventional Radiology 

www.bsir.org 

Macmillan Cancer Information 

https://www.macmillan.org.uk/cancer-information-and-support/treatment/types-of-treatment/chemotherapy/central-lines 

For general information about radiology departments, visit The Royal College of Radiologists 

www.goingfora.com  

NHS Direct 

For health advice or information, you can call NHS Direct on 0845 45647 or visit the website: www.nhsdirect.nhs.uk  

The NHS Clinical Knowledge Summaries website: www.cks.nhs.uk  

UCL Hospitals cannot accept responsibility for information provided by other organisations. 

Please contact the Vascular Access Team 

UCH Switchboard: 020 3447 0230 

Address:  

Interventional Radiology Imaging Department 

University College Hospital  

2nd Floor 

235 Euston Road  

London  

NW1 2BU 

Admin Queries Email: uclh.referrals.vassreqacc@nhs.net 

Website: www.uclh.nhs.uk

Procedures:  

The Imaging Department, Level 2 Podium in the main University College Hospital building with the entrance on Euston Road (see map below).  

Travelling to the hospital  

No car parking is available at the hospital. Street parking is limited and restricted to a maximum of two hours.  

Please note the University College Hospital lies outside, but very close to the Central London Congestion Charging Zone.  

Tube  

The nearest tube stations, which are within two minutes’ walk are:  

• Warren Street (Northern and Victoria lines)  
• Euston Square (Hammersmith & City, Circle and Metropolitan lines)  

Overground trains  

Euston, King Cross & St Pancras and Kings Cross Thames link railway stations are within 10-15 minutes’ walk.  

Bus  

Further travel information can be obtained from http://www.tfl.gov.uk 020 3054 4040 14  

Hospital transport service

If you need (and are eligible for) transport, please call:

020 3456 7010 (Mon to Fri 8am-8pm) to speak to a member of the Transport Assessment Booking Team.

If you have a clinical condition or mobility problem that is unlikely to improve you will be exempt from the assessment process. However, you will still need to contact the assessment team so that your transport can be booked. If your appointment is cancelled by the hospital or you cannot attend it, please call 020 7380 9757 to cancel your transport. 

University College Hospital Area Map