Adverse Events Associated With Midline Vascular Catheters

Abstract

Background: Central-line–associated bloodstream infections (CLABSIs) result in increased patient morbidity. Guidelines recommend against peripheral venous catheters when access is required for longer than 6 days, often leading to central venous catheter (CVC) placement. To improve vascular access device choice and reduce the potential risk of CLABSI, we implemented a quality improvement initiative comprised of a vascular access algorithm and introduction of a midline vascular access device (MVAD). We report complications associated with MVAD use including deep vein thrombosis (DVT), thrombophlebitis, and BSI. Methods: A prospective quality improvement assessment from October 2017 through March 2018. All MVADs were monitored for DVT, thrombophlebitis, and BSI. Insertion time and removal of MVAD were tracked, as well as presence of other vascular access devices. Results: From October 2017 through March 2018, 858 MVADs were inserted in 726 different patients, yielding 3,588 MVD days. In total, 6 primary BSIs occurred in patients with MVADs. In patients with only a MVAD, the rate was 0.72 BSI per 1,000 MVAD days, whereas patients with an MVAD as well as a CVC had a rate of 1.98 per 1,000 MVAD days. The overall CLABSI rate at the institution during this period of time was 1.24 per 1,000 CVC days. Also, 29 cases of thrombophlebitis occurred, for a rate of 3.84 per 1,000 catheter days in patients with only an MVAD compared to 4.63 per 1,000 catheter days in patients with an MVAD and a CVC. Also, 25 DVTs occurred during this time, resulting in a rate of 2.88 per 1,000 catheter days in patients with only an MVAD and 4.63 per 1,000 catheter days in patients with multiple vascular-access devices. A significant correlation was noted between MVAD indwell time and BSI (P = .0021) and thrombophlebitis (P = .0041). The median indwell time for patients experiencing BSI was 16.17 days ± 8.04 days, whereas the median indwell time for patients experiencing thrombophlebitis was 9.24 days ± 7.99 days. Conclusions: The implementation of a vascular-access algorithm including MVAD may effectively reduce CVC insertions and BSIs. The rate of BSI in MVAD was below that of CLABSI during the assessment period. Known complications associated with MVAD include DVTs and thrombophlebitis, which correlates with the duration of catheterization, and these risks appear to be further compounded in patients requiring multiple devices for vascular access. Further research into comparing the risk of vascular access of MVAD with CVC is warranted.Funding: NoneDisclosures: None

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

“…They acknowledged, however, that MC-related BSI rates are likely inaccurate because of inadequate surveillance. 18 In their prospective quality improvement program, Hankins et al 58 implemented a VAD selection algorithm that included an MC option and then monitored VADrelated outcomes. Although the MC-associated BSI rate was lower than the CLABSI rate during this initiative, they found significant correlations between MC dwell times and rates of BSI and thrombophlebitis, with an apparent increase in risk in patients who required multiple concurrent VADs.…”

“…Although the MC-associated BSI rate was lower than the CLABSI rate during this initiative, they found significant correlations between MC dwell times and rates of BSI and thrombophlebitis, with an apparent increase in risk in patients who required multiple concurrent VADs. 58 Thrombotic risk is multifactorial and is generally attributed to or worsened by vessel trauma, patient comorbidities, catheter-to-vein ratio, VAD securement, infusate characteristics, and longer VAD dwell times. 23,27,58 Because of the extended dwell time of the MC, the thrombotic risk has gained increasing attention.…”

“…58 Thrombotic risk is multifactorial and is generally attributed to or worsened by vessel trauma, patient comorbidities, catheter-to-vein ratio, VAD securement, infusate characteristics, and longer VAD dwell times. 23,27,58 Because of the extended dwell time of the MC, the thrombotic risk has gained increasing attention. Thrombus related to VADs may delay delivery of needed therapy, increase costs, and lead to significant adverse events, such as BSI and pulmonary embolism.…”