Going Home with a Midline Catheter: Your Care Guide

A midline catheter is a medium-length IV catheter — longer than a standard peripheral IV but shorter than a PICC line. It sits in a large vein in your upper arm and is used when you need IV therapy lasting one to four weeks. Because the tip does not extend all the way into the chest, midlines have some differences from PICCs in how they are cared for and what they can be used for.

This guide covers everything you need to know about managing your midline at home.

Understanding Your Midline

Your midline was inserted into a vein in your upper arm, typically using ultrasound guidance. The catheter is 8–20 cm long, and the tip sits within the upper arm or axillary vein region — not in the large central vein near the heart. This is what distinguishes it from a PICC.

What your midline can and cannot do:

✓ Deliver most standard IV antibiotics, antifungals, and fluids
✓ Deliver medications considered compatible with peripheral veins
✗ Cannot safely deliver highly irritating or concentrated solutions (certain chemotherapy agents, TPN/IV nutrition, concentrated potassium, vasopressors) — these require a central line
✗ Blood draws from a midline are generally not performed (unlike PICCs), as they can damage the device and reduce its lifespan

If your care team needs to draw blood while you have a midline, a separate arm stick is typically used.

Write down and keep handy:

Which arm: Left / Right
Insertion date: _____________
Expected removal date: _____________
Flush schedule: _____________

Flushing Your Midline

Flushing keeps the catheter clear of blood and medication residue. Your specific flush schedule and solution will be provided by your care team.

Typical flushing approach

Most midline catheters are flushed with normal saline only — many midlines do not require heparin. Your care team will tell you specifically whether heparin is part of your protocol.

Before every use: Flush with 10 mL saline to confirm patency (clear flow, no resistance) and clear any residue.

After every use: Flush with 10 mL saline to clear the medication from the catheter lumen.

When not in active use: Flush on the schedule your care team specifies — typically every 24 hours with saline.

How to flush

Wash hands thoroughly with soap and water (20 seconds minimum); dry completely.
Gather supplies: pre-filled 10 mL saline syringe, alcohol or CHG-alcohol wipe.
Scrub the needleless connector (the small cap at the end of the catheter) vigorously with an alcohol wipe for at least 15 seconds. Allow to air-dry 15 seconds.
Attach the saline syringe by twisting clockwise.
Gently and smoothly push the saline in. Do not force it if you feel significant resistance — stop and call your nurse.
Detach the syringe.

Never use a syringe smaller than 10 mL. Small syringes generate excessive pressure and can damage the catheter.

Dressing Care

The transparent dressing over your insertion site is your front-line defense against infection. Keeping it intact is essential.

Dressing change schedule

Transparent dressing (e.g., Tegaderm): Change every 7 days, or immediately if it becomes loose, wet, soiled, or the edges begin to lift.
Gauze under transparent dressing: Change every 48 hours (gauze traps moisture).

Dressing changes should be performed by a trained nurse — your home infusion nurse, visiting nurse, or at an outpatient clinic. Do not attempt to change the dressing yourself unless you have been specifically trained.

Protecting the dressing

Keep it dry. Use a waterproof PICC sleeve or wrap when showering.
Do not apply lotion, cream, or products near the dressing.
If the dressing begins to peel at the edges, do not try to press it back down. Call your nurse.
Loose clothing over the arm is fine; avoid tight sleeves, compression garments, or blood pressure cuffs on the midline arm.

Bathing with a Midline

Showering: Permitted with a waterproof sleeve or appropriate covering. Aim to keep water away from the dressing. After showering, check that the dressing is still intact and dry.

Bathing/submerging: Do not submerge the midline arm in bathwater, pools, hot tubs, lakes, or the ocean for the duration of use. Waterborne bacteria entering the dressing dramatically increases infection risk.

Swimming: Not permitted while the midline is in place.

Activity with a Midline

Midlines generally allow more activity than PICCs, but some precautions apply:

Generally fine:

Walking, daily activities, light exercise
Driving (if your condition otherwise allows)
Light lifting and normal household tasks

Avoid or limit:

Heavy lifting or vigorous use of the midline arm (rough twisting, pushing, pulling)
Contact sports or activities with risk of a direct hit to the arm
Submerging the arm (see above)
Blood pressure cuffs on the midline arm — always remind staff to use the other arm

Unlike a PICC, overhead reaching and more moderate arm activity are generally better tolerated with midlines because the catheter tip is not in the central vasculature. However, avoid any activity that causes pain or discomfort at the insertion site.

Phlebitis: A Common Midline Complication

The most common complication with midline catheters is phlebitis — inflammation of the vein. It occurs more frequently with midlines than with central catheters because the catheter tip sits in a smaller vein.

Signs of phlebitis:

Redness at or spreading from the insertion site
Warmth along the vein
A firm, rope-like feeling along the vein in the arm
Pain or tenderness along the arm
Swelling at the site

What to do: Report these signs to your nurse or home infusion nurse promptly. Mild phlebitis may be managed with warm compresses and elevation; in other cases the midline may need to be removed. Do not ignore these symptoms — they can progress.

Signs that go beyond simple phlebitis and require urgent attention:

A red streak extending away from the site (spreading infection)
Fever with the site changes
Pus or discharge from the site

Other Warning Signs

Call your home care nurse for:

Dressing loose, wet, lifting, or soiled
Site looks red, swollen, or has any discharge
Pain along the arm that is worsening
Midline appears to have shifted (looks longer outside the skin than when it was placed)
Resistance when flushing (do not force)
Any concern about the site or infusion

Go to the Emergency Room for:

Fever (≥38°C / 100.4°F) with shaking chills
Significant arm swelling spreading toward the shoulder or hand
Shortness of breath or chest pain
Signs of severe allergic reaction during infusion

Duration and Removal

Midline catheters are designed for use up to 4 weeks. Your care team will monitor its function and condition and remove it when treatment is complete or if it is no longer functioning safely.

Midline removal is quick and simple — no anesthesia, no stitches. The nurse applies gentle pressure at the site for a few minutes afterward. Brief tenderness and a small bruise are normal.

Differences Between a Midline and a PICC: Quick Comparison

Feature	Midline	PICC
Tip location	Upper arm / axillary vein	Central vein near heart
Blood draws	Generally not performed	Routinely done
TPN / IV nutrition	Not suitable	Suitable
Chemotherapy	Limited (check with team)	Suitable (most agents)
Heparin flush	Often not required	Sometimes required
Swimming	Not permitted	Not permitted
Max duration	~4 weeks	Weeks to months

This guide is for educational purposes and is not a substitute for the specific instructions provided by your care team.