From the Guidelines
Management protocols for a code during midline placement should follow standard Advanced Cardiac Life Support (ACLS) guidelines with specific considerations for the procedure, prioritizing immediate cessation of the procedure and activation of the emergency response system. When a code occurs during midline placement, it is crucial to stop the procedure immediately and call for help. The team should begin high-quality CPR with chest compressions at a rate of 100-120 compressions per minute and a depth of 2-2.4 inches if cardiac arrest is confirmed, as recommended by recent guidelines 1.
Key considerations in managing a code during midline placement include:
- Establishing a secure airway and providing ventilation with supplemental oxygen
- Administering epinephrine 1 mg IV every 3-5 minutes as the primary vasopressor
- Delivering defibrillation at 120-200 J biphasic or 360 J monophasic for shockable rhythms, followed by immediate CPR
- Considering potential procedure-specific causes such as vasovagal reaction, air embolism, pneumothorax, or anaphylaxis to materials used during placement
It is also important to document the event thoroughly, including timing of interventions and patient response. After successful resuscitation, the team should evaluate the patient for procedure continuation or termination based on clinical status and consider post-code monitoring in an intensive care setting. The specialized nature of midline placement complications requires team members to be familiar with both standard resuscitation protocols and procedure-specific interventions, as highlighted in recent studies 1.
In terms of preventing complications, the use of evidence-based recommendations such as maximal sterile barrier precautions, hand hygiene, and the use of alcohol-containing CHG for skin antisepsis can help mitigate the risk of infection during midline placement 1. However, in the event of a code, these preventive measures take a backseat to immediate resuscitative efforts.
From the Research
Management Protocols for a Code during Midline Placement
- The provided studies do not directly address the management protocols for a code during midline (peripherally inserted central catheter) placement.
- However, the studies discuss various aspects of cardiac arrest management, including the effect of epinephrine dosage 2, adherence to ACLS protocols 3, and the use of vasopressin 4.
- In the context of cardiac arrest, the studies suggest that adherence to ACLS protocols is crucial for successful return of spontaneous circulation (ROSC) 3.
- The use of vasopressin has been shown to increase coronary perfusion pressure in some patients with cardiac arrest 4.
- In cases of cardiac arrest in the catheterization laboratory, emergency cardiopulmonary bypass support has been used as a therapeutic option 5.
- While these studies do not provide specific guidance on managing a code during midline placement, they highlight the importance of following established protocols and considering alternative therapeutic options in cardiac arrest situations.
- The effect of course format on student performance in ACLS programs has also been studied, with results indicating that increased practical skill activities can improve student outcomes 6.