A GAVeCeLT-IVAS bundle for the Safe Insertion of Midline Catheters: The SIMiC protocol

Midline catheters (MCs) are widely used in clinical practice, and the insertion procedure may be associated with minor or major complications. Correct technique and adherence to specific strategies during placement are key factors that significantly affect complication rates and device longevity. This paper describes an insertion bundle-developed by the Italian Group of Long-Term Venous Access Devices (GAVeCeLT) and by the Italian Vascular Access Society (IVAS), and named "SIMiC" (Safe Insertion of Midline Catheters)-consisting of a few evidence-based strategies aimed at reducing all immediate, early, or late complications potentially associated with the insertion of MCs. The SIMiC bundle includes seven steps: (1) systematic ultrasound evaluation of the veins of the arms and the supra/infra-clavicular area; (2) choice of the most appropriate vein of the upper arm; (3) appropriate hand hygiene, proper skin antisepsis, and maximal barrier precautions; (4) ultrasound-guided venipuncture; (5) intra-procedural tip location, using infra/supraclavicular ultrasound scan; (6) sutureless securement, preferably using subcutaneous anchorage; (7) protection of the exit site with cyanoacrylate glue and semipermeable transparent membrane.