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

Abstract

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.

Ultrasound-guided placement of Midline catheters performed by Neurosurgery resident as a substitute for conventional central venous catheter placement in Neurosurgical Intensive Care Unit patients

“…MC has replaced certain parts of traditional CCVC indica-tions 10) . Emergence of MC use has attributed to the acceptable incidence of MC-related BSI documented by previous studies.…”

“…In a previous study, when the first attempt of MC insertion was achieved, the rate of MC-related venous thrombosis was 4.5%, but when the attempts were repeated three times or more, the venous thrombosis rate was increased up to 9% 17) . DVT of the upper arm can the potentially cause fatal complications resulting from any IV catheters 10) . The target vein of the MC is usually smaller than that of central veins.…”

“…Guideline recommend that infusates administered via MC should "ideally" be in the physiologic range of pH and osmolarity, which are compatible for peripheral infusion 10) . However, a range of pH and osmolarity of infusates and the list of medications with absolute necessities for central venous catheter (CVC) administration is not clearly established and are changing 9) .…”

“…However, a range of pH and osmolarity of infusates and the list of medications with absolute necessities for central venous catheter (CVC) administration is not clearly established and are changing 9) . Although this lack of evidence, guideline have been used as a clinical reference suggesting medications for CVC rather than peripheral IV catheter or MC 10) . Amiodarone > 2mg/mL as an acidic agent, dextrose > 20% in non-emergent situations, hypertonic saline, total parenteral nutrient, vesicants, calcium chloride, epoprostenol, potassium concentrate > 0.1mEq.mL and vasopressors require CVC infusion 10) .…”

“…A peripherally inserted central venous catheter (PICC) and a midline catheter (MC) can avoid the risk of insertion-related mechanical injury with an acceptable risk of catheter-related bloodstream infection (CRBSI) 9,10) . PICC is recommended for patients requiring IV therapy > 14 days 9) .…”