The 2016 Infusion Therapy Standards of Practice states, “VADs are not removed based solely on length of dwell time because there is no known optimum dwell time.”
Then what is the basis for this statement about midline dwell time of 29 days? That answer comes from a guidance document released by the FDA in 1995. This document included a list of information that must be included in the manufacturer’s original submission to the FDA to obtain clearance to sell the device in the United States. The manufacturer must classify the device into one of two groups – “Class II for short-term intravascular catheters (less than 30 days), Unclassified for long-term (more than 30 days) percutaneous intravascular catheters”. This classification is made long before there is any clinical use of the device, therefore clinical outcomes are not known when this submission is made.
Reasons for removal of all VADs should be based on clinical findings. What does the insertion site look like? Are there any complaints from the patient about the device? Is it still functioning without resistance to flushing and producing a blood return that is the color and consistency of whole blood? Is the catheter still needed for the patient’s plan of care? These are the factors to consider about removal of any VAD including midline catheters. So forget the clock or calendar to determine when the catheter should be removed.
Learn more about Midline Catheters in our newly updated course, Midline Catheters: What, Why, When.