A comparison of the incidence of midline catheter–associated bloodstream infections to that of central line–associated bloodstream infections in 5 acute care hospitals

Hogle, Nancy J.; Balzer, Krystal; Ross, Barbara; Wuerz, Lorelle; Greendyke, William; Furuya, E. Yoko; Simon, Matthew S.; Calfee, David P.

doi:10.1016/j.ajic.2019.11.004

Cited by 12 publications

(24 citation statements)

References 5 publications

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“…15 For example, several observational studies have suggested that midline complications, including infection, thrombosis and failure, may rival or outnumber those from PICCs. [16][17][18][19] However, almost all these studies are limited by retrospective design, single-center evaluations, and inclusion of heterogeneous patient populations. Thus, for short-term venous access, the optimal device that balances safety and meets clinical needs is unclear.…”

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Safety and Outcomes of Midline Catheters vs Peripherally Inserted Central Catheters for Patients With Short-term Indications

et al. 2022

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IMPORTANCE Peripherally inserted central catheters (PICCs) and midlines are frequently used for short-term venous access; whether one is safer than the other in this setting has not been adequately reported.OBJECTIVE To compare outcomes between patients who had a PICC vs midline placed for the indication of difficult vascular access or antibiotic therapy for 30 or fewer days. DESIGN, SETTING, AND PARTICIPANTSThis cohort study analyzed data from a multihospital registry including patients admitted to a participating site from December 2017 through January 2020 who had a PICC or midline placement for the indications of difficult venous access or intravenous antibiotic therapy prescribed for 30 or fewer days. Data were analyzed from October 2020 to March 2021. EXPOSURES PICC and midline placement.MAIN OUTCOMES AND MEASURES Major complications, including a composite of symptomatic catheter-associated deep vein thrombosis (DVT), catheter-related bloodstream infection, and catheter occlusion. Logistic regression and Cox proportional hazards regression models (taking into account catheter dwell) were used to estimate risk for major complications, adjusting for patient and device characteristics and the clustered nature of the data. Sensitivity analyses limiting analyses to 10 days of device dwell were performed.RESULTS Data on 10 863 patients, 5758 with PICCs and 5105 with midlines (median [IQR] age of device recipients, 64.8 [53.4-75.4] years; 5741 [52.8%] were female), were included. After adjusting for patient characteristics, comorbidities, catheter lumens, and dwell time in logit models, patients who received PICCs had a greater risk of developing a major complication compared with those who received midlines (odds ratio, 1.99; 95% CI, 1.61-2.47). Reduction in complications stemmed from lower rates of occlusion (2.1% vs 7.0%; P < .001) and bloodstream infection (0.4% vs 1.6%; P < .001) in midlines vs PICCs; no significant difference in the risk of DVT between PICCs and midlines was observed. In time-to-event models, similar outcomes for bloodstream infection and catheter occlusion were noted; however, the risk of DVT events was lower in patients who received PICCs vs midlines (hazard ratio, 0.53; 95% CI, 0.38-0.74). Results were robust to sensitivity analyses. CONCLUSIONS AND RELEVANCEIn this cohort study among patients with placement of midline catheters vs PICCs for short-term indications, midlines were associated with a lower risk of bloodstream infection and occlusion compared with PICCs. Whether DVT risk is similar or greater with midlines compared with PICCs for short-term use is unclear. Randomized clinical trials comparing these devices for this indication are needed.

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Safety and Outcomes of Midline Catheters vs Peripherally Inserted Central Catheters for Patients With Short-term Indications

et al. 2022

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“…7,14,23,24,55,63,64 It is equally imperative that VAD-related outcomes are effectively monitored, analyzed, and disseminated to further optimize patient outcomes in the rapidly evolving environment of critical care. 2,11,12,14,18 CCN…”

Section: Discussionmentioning

confidence: 99%

“…3,7,8,15 Another possible patient satisfier is the potential to collect blood specimens from the MC, 9,42 although the 2021 INS standards indicate that no evidence is yet available to guide technique or validate the accuracy of blood specimen collection from the MC. 23 The exponential increase in MC use, particularly in difficult venous access scenarios and as a CVC alternative, 8,11,12,14,32,43 has stimulated expanded research into the benefits and risks of peripheral VAD use.…”

Section: Questions To Considermentioning

confidence: 99%

“…This process is often used in an effort to avoid reportable hospital-acquired infections. 5,[7][8][9][10][11][12][13][14] Use of the midline catheter (MC) has undergone a resurgence because of the need to provide a long-term peripheral vascular access option that is not Background The goals of infusion therapy are to preserve vascular health and safely deliver needed treatment. Achieving these goals is challenging in critical care because of the complexity of the treatment required.…”

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Does the Midline Peripheral Intravenous Catheter Have a Place in Critical Care?

Nickel

2021

Critical Care Nurse

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Background The goals of infusion therapy are to preserve vascular health and safely deliver needed treatment. Achieving these goals is challenging in critical care because of the complexity of the treatment required. Daily justification of retaining an existing central venous catheter also creates urgency to change to a peripheral vascular access device. The midline catheter has had a resurgence in use because of the need for a long-term peripheral vascular access device not linked to central catheter–associated bloodstream infection risk. Objective To review the characteristics of midline catheters, the benefits and risks of midline catheters, and current evidence regarding midline catheter use in critical care. Results Research related to midline catheters has greatly expanded the body of knowledge regarding vascular access device selection and midline catheter use. Discussion Although the quality and results of research on vascular access devices vary widely, a more accurate safety profile is emerging to illustrate how midline catheter use can support the goals of infusion therapy. Conclusions Optimizing vascular access device selection requires recognition that every vascular access device can cause patient harm. Although the midline catheter appears to fill an important niche in infusion therapy, use of the midline catheter should be carefully evaluated. Midline catheters should not be used as a catheter-associated bloodstream infection prevention strategy, should be inserted to administer peripherally compatible solutions, and should be considered for short-term continuous vesicant therapy only in emergent situations until more definitive vascular access can be achieved.

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“…Midline catheters are also peripherally inserted vascular devices that terminate outside the great vessels of the chest, and it was believed that they were less likely to result in CLABSI or DVT 17. However, as midline catheter use has increased, several observational studies have noted that complication rates of infection and thrombosis may approach those of PICC lines 18 19. These studies, however, are not without shortcomings (eg, retrospective design, heterogeneous patient populations, single-centre evaluations).…”

Section: Safety and Outcomes Of Midline Catheters Vs Peripherally Ins...mentioning

confidence: 99%

Quality and safety in the literature: October 2022

2022

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Healthcare quality and safety span multiple topics across the spectrum of academic and clinical disciplines. Keeping abreast of the rapidly growing body of work can be challenging. In this series, we provide succinct summaries of selected relevant studies published in the last several months. Some articles will focus on a particular theme, whereas others will highlight unique publications from high-impact medical journals.

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A comparison of the incidence of midline catheter–associated bloodstream infections to that of central line–associated bloodstream infections in 5 acute care hospitals

Cited by 12 publications

References 5 publications

Safety and Outcomes of Midline Catheters vs Peripherally Inserted Central Catheters for Patients With Short-term Indications

Safety and Outcomes of Midline Catheters vs Peripherally Inserted Central Catheters for Patients With Short-term Indications

Does the Midline Peripheral Intravenous Catheter Have a Place in Critical Care?

Quality and safety in the literature: October 2022

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