The Practice and Complications of Midline Catheters: A Systematic Review

Abstract

OBJECTIVE: Midline catheters are considered “midway” regarding vascular access. The objective of this systematic review was to explore the current practice, dwell time, and complication rates of midline catheters. DESIGN: Systematic review. SETTING: Search on four databases, PubMed, CINAHL, Scopus, and Embase, were conducted for English language articles published after the year 2000. MEASUREMENTS AND MAIN RESULTS: A total of 987 articles were identified, of which 31 manuscripts met the inclusion criteria and were selected for review. Quality assurance was performed based on the Newcastle-Ottawa score. Average dwell time and complication rates were calculated for studies involving adult patients and adjusted for sample size. This analysis included data from the placement of 18,972 midline catheters across five countries. Aside from two randomized control trials, most of the studies analyzed were cohort studies. One pediatric and two neonatal studies were included. The average dwell time was 16.3 days (n = 4,412). The adjusted mean infection rate was 0.28/1,000 catheter days, with 64% of studies not reporting any infection with midline catheter. The failure rate of midline catheters was 12.5%. Adjusted average rates of other significant complications included the following: deep vein thrombosis (4.1%), dislodgement (5.0%), occlusion (3.8%), phlebitis (3.4%), and infiltration (1.9%). Conclusions: The dwell times and failure rates of midline catheters compare favorably against published data on other types of catheters. Their infection rates are also lower than the reported rates of central venous catheters; however, they have a higher rate of mechanical complications. Active surveillance of infections due to midline catheters is recommended. More data are needed from pediatric and neonatal populations.

A Retrospective Assessment of Midline Catheter Failures Focusing on Catheter Composition

“…Similarly, the complication rate was reported at 10.3% in a multicenter, prospective cohort study of aggregated data on 11 161 midline catheters from 12 hospitals 5. Furthermore, a systematic review of 31 articles including 6047 midline catheter insertions showed a similar failure rate of 12.5% 21. None of these studies controlled for catheter material.…”

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

“…14,16,51 Unfortunately, MC-related research studies are often plagued with the limitations common to VAD-related research as a whole: retrospective analyses; single-site studies; small sample sizes; risk of bias; documentation gaps; and wide variability in research methods, VAD-related adverse event definitions, inclusion criteria, and VAD characteristics. 14,18,37,40,[53][54][55] The lack of high-quality VAD-related randomized controlled trials reduces the applicability of research recommendations to guide VAD selection and management. 6 The following paragraphs include examples of recent MC-related studies suggesting that MCs may be associated with a higher risk of adverse events than previously thought.…”

“…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.…”

Reducing Central Line Associated Bloodstream Infections (CLABSIs) by Reducing Central Line Days

“…Midline catheter programs are used by hospitals to avoid CLABSIs and associated financial penalties, an attractive benefit for any healthcare system [31]. Midline catheters can be associated with significantly fewer central line days, as well as significant cost savings (insertion of a midline being < $90), with multiple teams possibly being utilized for their placement (house staff, vascular access nurses, interventional radiology) [32][33][34].…”