The safety and efficacy of midlines compared to peripherally inserted central catheters for adult cystic fibrosis patients: A retrospective, observational study

Sharp, Rebecca; Esterman, Adrian; McCutcheon, Helen; Hearse, Neville; Cummings, Melita

doi:10.1016/j.ijnurstu.2013.09.002

Cited by 46 publications

(62 citation statements)

References 31 publications

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“…The median dwell time for midline catheters was lower than the potential 29 days claimed by the manufacture to be the maximum dwell time and thus, a major advantage for their use. However, the dwell time was comparable to previous reports, although significantly lower than what has been reported in relatively young patients with cystic fibrosis (mean 22 days, range 1‐59) …”

Section: Discussionsupporting

confidence: 87%

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The clinical performance of midline catheters—An observational study

Madsen

Sloth

Illum

et al. 2019

Acta Anaesthesiol Scand

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Background The use of peripheral venous catheters (PVCs) is hampered by short dwell time, and central venous catheters (CVCs) are often preferred for medium‐ to long‐time intravenous treatment. Ultrasound techniques allow for easy catheter insertion into the major veins of the upper arm. A new generation of midline catheters, PowerGlide Pro, utilises a one‐hand Seldinger technique and can be inserted by one single operator without assistance. This study aimed to evaluate the clinical performance of the PowerGlide Pro midline catheter. Methods Consecutively inserted midline catheters were followed in a prospective, observational quality control study. Endpoints were dwell time, the incidence of premature catheter removal, causes of catheter removal and the dwell time and incidence rates of predefined subgroups representing potential effect modifiers. Results Hundred midline catheters, of which 98 were accessible to follow‐up, were inserted in 70 patients. Median dwell time was 8 days and 60 catheters were removed before the indication for intravenous therapy had ceased. The overall incidence for premature catheter removal was 71.8/1000 days and no significant effects of subgroups (sex, body mass index, catheter reinsertions, significant comorbidity, anticoagulant therapy, irritant infusions) were identified for either dwell time or the incidence rate for premature midline catheter removal. The most frequent reasons for premature catheter removal were pain during infusion, clotted catheter or signs of infection. Conclusion The median dwell time of the midline catheters was 8 days with substantial variation, whereas the incidence for premature catheter removal was 71.8/1000 catheter days. The majority of midline catheters were removed prematurely.

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Section: Discussionsupporting

confidence: 87%

“…Pain during infusion was an important cause of catheter removal. Only one other study registered pain as an adverse event and reported its presence in 9/213 midline catheters . Pain elicited by infusion may be caused by either irritant qualities of the infusion or vessel blockage proximal to the catheter tip.…”

Section: Discussionmentioning

confidence: 99%

The clinical performance of midline catheters—An observational study

Madsen

Sloth

Illum

et al. 2019

Acta Anaesthesiol Scand

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“…infusion ports and tunneled catheters) are available for venous access and some patients may not require central venous access for delivery of irritants or vesicants, the ‘reflexive’ use of PICCs should be reconsidered in this population. The use of midlines (devices that terminate in arm veins as opposed to central chest veins) may also prove useful in this subset if short‐term administration of non‐vesicant or irritant substances is being considered . At the very least, this study and the available evidence call for a mindful approach when selecting PICCs as the vascular device of choice in patients with malignancies .…”

Section: Discussionmentioning

confidence: 99%

Peripherally inserted central catheter‐related deep vein thrombosis: contemporary patterns and predictors

Chopra

Ratz

Kuhn

et al. 2014

Journal of Thrombosis and Haemostasis

138

121

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Summary Background Despite growing use, peripherally inserted central catheters (PICCs) are associated with risk of deep vein thrombosis (DVT). We designed a study to determine patient, provider and device factors associated with this outcome. Methods This was a retrospective cohort study of adults who underwent PICC placement between 1 June 2009 to 30 June 2012. Symptomatic PICC‐associated DVT was confirmed by ultrasound. Because PICCs are also recognized risk factors for lower‐extremity DVT, lower‐extremity DVT occurring while the PICC was in situ was included. Multivariable logistic and Cox‐proportional hazards regression models were fit to examine the association between covariates specified a priori and PICC‐DVT. Odds ratios (ORs) and hazard ratios (HRs) with corresponding 95% confidence intervals (CIs) were generated. Results Of 966 unique PICC placements, 33 patients developed symptomatic PICC‐associated DVT and 9 developed lower‐extremity DVT, accounting for 42 thrombotic events. On bivariate analysis, recent diagnosis of cancer, interventional radiology placement, chemotherapy administration, number of lumens and PICC‐gauge were associated with PICC‐DVT. Following multivariable adjustment, recent cancer diagnosis (OR 1.95 [95% CI 1.01–3.76]) and PICC gauge (HR 2.21 [95%CI 1.04–4.70] and HR 3.56 [95%CI 1.31–9.66] for 5‐Fr and 6‐Fr PICCs, respectively) remained associated with thrombosis. Conclusions Recent diagnosis of cancer and PICC gauge are associated with PICC‐DVT. These findings have important clinical ramifications and suggest that placement of large gauge PICCs or PICCs in patients with cancer may provoke thrombosis. Improved policies and procedural oversights in these areas appear necessary to prevent PICC‐DVT.

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“…The remaining patients in the Tufts study had other types of vascular access that did not include midlines [ 4 , 5 ]. A retrospective analysis of adult patients with cystic fibrosis who received a PICC or midline for antibiotic administration found no difference in the rate of adverse events or line removal [ 13 ]. In contrast, an observational study of 50,470 patients who received a central venous catheter for home infusion therapy found that patients with midlines had a higher incidence of total complications and catheter dysfunction but significantly less bloodstream infections as compared to patients with PICC lines [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

Risk factors for readmission in patients discharged with outpatient parenteral antimicrobial therapy: a retrospective cohort study

Huang

Ruhe

Lerner

et al. 2018

BMC Pharmacol Toxicol

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BackgroundOutpatient parenteral antimicrobial therapy (OPAT) is a practical and effective way of delivering antimicrobial therapy, but may be associated with significant risk for hospital readmission. This study aimed to elucidate risk factors related to 30-day readmissions in patients who were discharged with OPAT at Mount Sinai Beth Israel (MSBI).MethodsThis IRB approved retrospective cohort study included patients who were at least 18 years or older, admitted to MSBI from August 2015 to March 2016, and discharged to receive OPAT. Patients with intravenous antibiotics prescribed for chronic suppression or planned readmission within 30 days were excluded. The main outcome was readmission to the hospital within 30 days from previous hospital discharge. Univariate and logistic regression analyses were performed to determine predictors of 30-day readmission.ResultsThere were a total of 200 patients included in the analysis; the median age was 60 years, 65.5% were male, and the median Charlson score was 2. A total of 155 (78%) patients received a peripherally inserted central catheter (PICC); the remainder was discharged with a midline. The most common medications prescribed for OPAT included cephalosporins (41%), vancomycin (31%), carbapenems (23%), and penicillins (16%). A total of 42 patients (21%) were readmitted within 30 days after previous discharge. Discharge to a skilled nursing facility or subacute rehabilitation center was found to be an independent predictor of readmission on logistic regression analyses (p < 0.05).ConclusionReadmissions are common in patients discharged with OPAT. Recognizing predictors of readmission may help determine strategies to optimize care.

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The safety and efficacy of midlines compared to peripherally inserted central catheters for adult cystic fibrosis patients: A retrospective, observational study

Cited by 46 publications

References 31 publications

The clinical performance of midline catheters—An observational study

The clinical performance of midline catheters—An observational study

Peripherally inserted central catheter‐related deep vein thrombosis: contemporary patterns and predictors

Risk factors for readmission in patients discharged with outpatient parenteral antimicrobial therapy: a retrospective cohort study

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