Comparison of Venous Thrombosis Complications in Midlines Versus Peripherally Inserted Central Catheters: Are Midlines the Safer Option?

Bahl, Amit; Karabon, Patrick; Chu, David

doi:10.1177/1076029619839150

Cited by 57 publications

(84 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“… 31-36 However, recent reports indicate thrombotic events may also be associated with devices in distant locations, which might explain the high catheter failure rate observed in the control legs. 33 , 37-39 …”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Investigation of the role of infusate properties related to midline catheter failure in an ovine model

Ryder¹,

Gunther

Nishikawa³

et al. 2020

American Journal of Health-System Pharmacy

View full text Add to dashboard Cite

Purpose Infusate osmolarity, pH, and cytotoxicity were investigated as risk factors for midline catheter failure. Methods An experimental, randomized, controlled, blinded trial was conducted using an ovine model. Two 10-cm, 18-gauge single-lumen midline catheters were inserted into the cephalic veins of sheep. The animals were divided into 6 study arms and were administered solutions of vancomycin 4 mg/mL (a low-cytotoxicity infusate) or 10 mg/mL (a high-cytotoxicity infusate), doxycycline 1 mg/mL (an acidic infusate), or acyclovir 3.5 mg/mL (an alkaline infusate) and 0.9% sodium chloride injection; or 1 of 2 premixed Clinimix (amino acids in dextrose; Baxter International) products with respective osmolarities of 675 mOsm/L (a low-osmolarity infusate) and 930 mOsm/L (a mid-osmolarity infusate). Contralateral legs were infused with 0.9% sodium chloride injection for control purposes. Catheter failure was evaluated by assessment of adverse clinical symptoms (swelling, pain, leakage, and occlusion). A quantitative vessel injury score (VIS) was calculated by grading 4 histopathological features: inflammation, mural thrombus, necrosis, and perivascular reaction. Results Among 20 sheep included in the study, the overall catheter failure rate was 95% for test catheters (median time to failure, 7.5 days; range, 3–14 days), while 60% of the control catheters failed before or concurrently (median time to failure, 7 days; range, 4.5–14 days). Four of the 6 study arms (all but the Clinimix 675-mOsm/L and acyclovir 3.5-mg/mL arms) demonstrated an increase in mean VIS of ≥77% in test vs control legs (P ≤ 0.034). Both pain and swelling occurred at higher rates in test vs control legs: 65% vs 10% and 70% vs 50%, respectively. The mean difference in rates of occlusive pericatheter mural thrombus between the test and control arms was statistically significant for the vancomycin 10-mg/mL (P = 0.0476), Clinimix 930-mOsm/L (P = 0.0406), and doxycycline 1-mg/mL (P = 0.032) arms. Conclusion Administration of infusates of varied pH, osmolarity, and cytotoxicity via midline catheter resulted in severe vascular injury and premature catheter failure; therefore, the tested infusates should not be infused via midline catheters.

show abstract

Section: Discussionmentioning

confidence: 99%

“…Initially, this was not seen as an issue; however, recent reports indicate an association of a venous thrombotic event with devices in distant locations. 33 , 37-39 The ramifications of these limitations are not clear but may explain in part the unanticipated degree of severity of injury observed in control veins.…”

Section: Discussionmentioning

confidence: 99%

Investigation of the role of infusate properties related to midline catheter failure in an ovine model

Ryder¹,

Gunther

Nishikawa³

et al. 2020

American Journal of Health-System Pharmacy

View full text Add to dashboard Cite

show abstract

“…We found that PICC‐RT was associated with the diameter of the catheters (>4Fr), consistent with previous evidence (Chopra et al, 2017; Koo et al., 2018). Mechanically, larger PICC devices are more likely to cause endothelial damage and vascular reactivity as well as up‐regulate the coagulation process (Bahl et al., 2019; Song et al., 2020). For older patients, a 4‐Fr PICC has been the optimal choice (Chopra et al, 2017; Koo et al., 2018).…”

Section: Discussionmentioning

confidence: 99%

Incidence and risk factors of symptomatic thrombosis related to peripherally inserted central catheter in patients with lung cancer

Chen

Wan

Zhu

2020

Journal of Advanced Nursing

View full text Add to dashboard Cite

Aims To determine the incidence and risk factors associated with peripherally inserted central catheter‐related thrombosis (PICC‐RT) in patients with lung cancer. Design A retrospective cross‐sectional design. Methods Patients with lung cancer receiving PICC insertion during 1 March 2014‐31 May 2019 at a tertiary hospital in Shanghai, China were enrolled (N = 748). Symptomatic PICC‐RT was confirmed by Doppler ultrasonography in the presence of clinical symptoms and signs. Univariate and multivariate logistic regression analyses were performed to identify risk factors of symptomatic PICC‐RT. Results Among the patients (mean age, 60.7 years; males, 67.1%), 55 (7.35%) had symptomatic PICC‐RT. Based on the multivariate analysis, history of smoking [OR 2.49 (1.13–5.46), p < .05], use of Carboplatin [OR 2.23 (1.19–4.17), p < .05] or Docetaxel [OR 7.23 (1.65–31.56), p < .05], PICC size [OR 3.52 (1.78–6.99), p < .001], and level of D‐dimer [OR 5.32 (2.39–11.83), p < .001] were significant risk factors of PICC‐RT. Conclusion Several modifiable factors (e.g., PICC size and level of D‐dimer) were related to PICC‐RT. In the future, prospective studies are warranted to examine whether those factors could increase the risk of PICC‐RT. Meanwhile, healthcare professionals are recommended to perform a comprehensive assessment of the patients receiving PICC insertion. Close attention should be paid to those at risk for PICC‐RT. Impact Identification of risk factors associated with PICC‐RT is an important step towards individualizing the care plan for patients receiving PICC. Our findings provided evidence for the management of PICC‐RT in patients with lung cancer. In clinical practice, nurses could deliver appropriate interventions against modifiable risk factors to reduce the risk of PICC‐RT.

show abstract

“…Recent studies reported a CRT rate for MCs ranging from 4% to 11%, 13,14 even if there is some margin of uncertainty due to the different terminology adopted by the different studies, so that it is not always clear whether the device is a standard midclavicular 20- to 25-cm MC or 8- to 10-cm ‘short’ midline. 2…”

Section: Discussionmentioning

confidence: 99%

Ultrasound-guided tip location of midline catheters

et al. 2020

View full text Add to dashboard Cite

Introduction: Midline catheters are widely used in clinical practice. Proper placement of midline catheter tip is usually assessed only by aspirating blood and flushing with normal saline without resistance. Purpose: To describe the ultrasound-guided tip location for midline catheters and its feasibility and to compare incidence of catheter-related venous thrombosis associated with or without ultrasound tip localization. Methods: The ultrasound-guided tip location is described step by step. Feasibility of the technique and incidence of catheter-related venous thrombosis were measured (study group) and compared with two historical groups: study group, 20-cm midline catheters inserted with ultrasound-guided tip location; group 1, 25-cm midline catheters inserted without ultrasound-guided tip location and group 2, 20-cm midline catheters inserted without ultrasound-guided tip location. Results: In the study group, ultrasound-guided tip location was easily feasible in 98.9% of patients. Incidence of catheter-related venous thrombosis was 2.42% in control group 1, 9% in control group 2 and 2.62% in the study group. Discussion: In the study group and control group 1, the tip was placed in the axillary vein, about 3 cm distal to the clavicle and in the subclavian vein. In control group 2, the tip was probably located at the transition between the axillary and the subclavian vein. It is possible that such position may have been associated with an increased incidence of catheter-related venous thrombosis. Conclusion: The ideal position of the tip of a midline catheter might be inside the axillary vein, about 3 cm distal to the axillary-subclavian transition or inside the subclavian vein. Ultrasound-guided tip location is safe, inexpensive, easy and potentially useful during midline catheters insertion.

show abstract

Comparison of Venous Thrombosis Complications in Midlines Versus Peripherally Inserted Central Catheters: Are Midlines the Safer Option?

Cited by 57 publications

References 28 publications

Investigation of the role of infusate properties related to midline catheter failure in an ovine model

Investigation of the role of infusate properties related to midline catheter failure in an ovine model

Incidence and risk factors of symptomatic thrombosis related to peripherally inserted central catheter in patients with lung cancer

Ultrasound-guided tip location of midline catheters

Contact Info

Product

Resources

About