The PICC and Midline Virtual Ward: Building a vascular access catheter preservation programme

Dr Mary O’Regan – Consultant in anaesthesia and critical care medicine

Hywel Dda University Health Board


Many hospital and community-based patients receive intravenous medication via a PICC (peripherally inserted central catheter) or Midline (long peripheral cannula). These devices can be indwelling for many months facilitating the community-based care of patients who formerly endured long in-patient stays. They offer clear benefits but are associated with significant complications E.g. Thrombosis and catheter-related blood-stream infection.

Deep vein thrombosis of the upper limb associated with a PICC line
Deep vein thrombosis of the upper limb associated with a PICC line

Many healthcare staff are not confident managing PICC and Midlines. Substandard catheter care may be linked to adverse catheter events, morbidity, mortality, increased health-care costs and poor patient experience. Harm from PICC and Midline complications does not seem to be on the national radar and data is not subject to local or national surveillance.

Project Aims

Employing targeted staff education, patient engagement and regular real and virtual ward-rounds we wanted oversee the management of PICC and Midlines in our hospitals and communities. We aspired to unlock the potential of our staff and build a competent multidisciplinary network of staff and patient-partners that:


Key Outcomes

Next Steps

Bevan Exemplar Experience

Being a Bevan Exemplar gave me the tools I needed to transform a personal aspiration into a multidisciplinary project with momentum.