Care of the Midline at home

Disclaimer: This fact sheet is for education purposes only. Please consult with your doctor or other health professional to make sure this information is right for your child.

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If your child has had a midline catheter inserted, you will need to take care of it at home to keep it clean and working well. This guide provides information to assist you in addition to the education you will have received by your child’s nurse or doctor.

What is a midline and what does it look like?

A midline is a type of catheter, a small tube, usually 5-8 cm long that is inserted into a vein in the upper arm up to the armpit.

The purpose of a midline is to administer medication, usually antibiotics, over a period of time.

The midline is secured to the arm using a clear dressing and a securement device. The dressing covers the midline and keeps it clean and dry to prevent infection. The securement device prevents the midline from being accidently pulled back or pulled out. An elastic bandage (such as Tubifast) may also be used for extra support and comfort.

The midline is checked by the ‘Hospital in the home’ nurse (HITH) at every home visit. The midline will be removed when treatment is completed, either at home or in the hospital. HITH nursing staff will liaise with you on where and when the midline will be removed. 

General care of the midline

  • Strict care of your child’s midline is very important to prevent infection. This involves careful hand washing and wearing gloves when connecting and disconnecting the infusion sets from the midline, and also during dressing changes.
  • Make sure that the dressing covering the midline is kept clean and dry at all times.
  • When bathing your child make sure that the midline is kept out of the water to prevent the risk of infection. When showering, cover the midline with plastic cling wrap and tape each end down to keep it dry.
  • Keep the midline secure and regularly check the dressing to make sure it’s not coming off.
  • Dressings are changed every 7 days. This involves carefully removing the old dressing and cleaning the skin around the midline with antiseptic solution, before applying a new clean dressing.
  • Check the midline regularly to make sure that it’s not kinked and the midline outside the body has not changed length.
  • Take care when dressing your child to make sure that the midline is not accidently pulled back or pulled out.
  • Make sure that your child does not participate in contact sports or vigorous play while undergoing treatment. This is to avoid potential damage to the midline. Exceptions apply to children who have physiotherapy sessions.
  • Make sure the Needleless Access Device (NAD) on the end of the catheter stays connected at all times.
  • Do not allow anyone to touch the midline.

When to seek help:

If your child has any of the following problems, follow the instructions below and immediately contact either the HITH nurse or your child’s relevant after hours medical team.

Problem

What to do

The midline is accidently removed

  • Lie your child down and apply firm pressure over the site with cotton wool or a clean disposable towel for 5 minutes to stop the bleeding. Then cover the site with a spare dressing.

The infusor becomes disconnected from the midline

  • Clamp the midline, do not reconnect.

The midline breaks

  • Stop the infusion.
  • Using the clamp on the midline, clamp above the break closest to the midline insertion site (skin). If unable to clamp the midline, bend the midline above the break and tape the midline firmly together. Cover with a gauze square or a clean disposable towel to keep clean. Secure the midline with a spare dressing.
The Needleless Access Device (NAD) has fallen off.
  • Clamp the mfirmly together.

  • Attach a new NAD to the end of the midline, DO NOT replace the old NAD back onto the midline.

  • If you do not have a spare NAD then wrap the end of the midline with the spare dressing and apply tape around this dressing and midline.

Your child develops fevers, swelling, redness or pain at the midline entry site or up the arm

  • Clamp the midline and stop the infusor.

The dressing is loose, wet or dirty

  • Do not remove the dressing; secure the dressing with clean spare dressing.

The midline appears longer or shorter

  • Secure the midline with spare dressing to prevent further movement.

Leakage or drainage at the midline site

  • Clamp the midline and stop the infusor.

Blood in the midline

  • Clamp the midline and stop the infusor.

Contact details

HITH Service (Westmead):

Contact Times: 7.30am to 9.30pm 7 days a week

Contact Numbers: Office: 98453857 / Morning nurse mobile: 0417226650 / Afternoon nurse mobile: 0419226590

HITH Service (Randwick):

Contact times: 7.30am to 9.30pm 7 days a week

Contact numbers: Office: 9382 0228 / Nurse Mobile: 0418760411 / Afternoon Nurse Mobile: 0409954567

After Hours: Please phone the Children’s Hospital at Westmead on 98450000 or the Sydney Children’s Hospital Randwick on 93821111 and ask to speak to the Registrar on call for your child’s consultant for further instructions.

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The Children's Hospital at Westmead
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Sydney Children's Hospital, Randwick
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Hunter New England Kids Health
www.hnekidshealth.nsw.gov.au

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