The major shift to the use of peripheral vascular access devices (PVADs) to avoid central line-associated blood stream infections (CLABSIs) has created major patient safety challenges.   Administration of medications inappropriate for peripheral administration, disregard for catheter-to-vein ratio, and repeated replacement of failed catheters is supposedly tolerated as a trade-off for CLABSI reduction. However, CLABSI rates have increased while PVAD bloodstream infection (BSI) rates are nearly equivalent to CLABSI rates, and at the same time, thrombotic events have increased with the loss of peripheral vasculature. Can we improve on these outcomes? The peripheral midclavicular catheter with the tip positioned at the juncture of the axillary and subclavian vein was abandoned in the mid-1990s due to a perceived increase in catheter-related venous thrombosis. More recently, global experience with catheter tip position in the proximal axillary vein and distal subclavian vein has demonstrated improved outcomes compared to other peripheral catheters. What are the differences in practice and evidence on PVADs from the time of the INS and AVA position statements until now? In this session, we will examine the differences in outcomes among PVADs, specifically midclavicular (midline) and midline (mini-midline) catheter tip positions as well as discuss implementation of the midclavicular catheter.

Learning Objectives: At the conclusion of this session, participants will be able to:

• Describe the flow dynamics, anatomical differences, and complications between superficial upper extremity veins, deep basilic or brachial vein, axillary, and subclavian catheter tip positions.
• Explain the appropriate selection and complication risk between PVAD catheter tip positions.  
• Discuss a process for implementation of midclavicular catheters into clinical practice: continuous quality improvement.

Contact Hours: 1
CRNI® RUs: 2