The Safety of Midline Catheters for Intravenous Therapy at a Large Academic Medical Center

Abstract

Background: Midline catheters (MCs) have arisen as alternatives to peripherally inserted central catheters (PICCs) for both general intravenous therapy and extended outpatient parenteral therapy. However, there is a lack of data concerning the safety of medication therapy through midline for extended durations. Objective: The purpose of this study is to evaluate the safety of MCs for extended intravenous use. Methods: This was a retrospective cohort study evaluating patients who received intravenous therapy through an MC at a tertiary care academic medical center. The primary end point was the incidence of composite catheter-related adverse events that included local events, catheter dislodgment, infiltration, catheter occlusion, catheter-related venous thromboembolism, extravasation, and line-associated infection. Results: A total of 82 MC placements and 50 PICC placements were included; 50 MCs were for outpatient parenteral antimicrobial therapy, and 32 were for inpatient intravenous use. There were 21 complications per 1000 catheter-days in the outpatient group and 7 complications per 1000 catheter-days in the PICC group ( P = 0.91). The median time to complication in both groups was 8 days. The antimicrobial classes commonly associated with complications were cephalosporins, carbapenems, and penicillins. Conclusion and Relevance: Our results suggest that intravenous therapy with MCs is generally safe for prolonged courses that do not exceed 14 days as compared with PICC lines, which can be placed for months. There is still limited evidence for the use of MCs between 14 and 28 days of therapy. This study can help guide our selection of intravenous catheters for the purpose of outpatient antimicrobial therapy.

Efficacy and Safety of Midline Catheters with Integrated Wire Accelerated Seldinger Technique

“…This may be owing to the short length of the catheter, and the fixture consists of a simple sticker, allowing easy and inadvertent extrusion. The adverse events in this study accounted for 27.4% (16.2/1,000 catheter days), which was higher than the average complication rate of 10% (11-65.7/1,000 catheter days) reported [ 8 - 10 ]. This may be because the scope of adverse events was wider in this study.…”

“…In this study, however, the rate of major complication such as CA-BSI and symptomatic DVT was low (2.6%). CA-BSIs are reported to occur at <0.2% to 2.0% or 0.1 to 0.2/1,000 catheter days [ 5 , 8 - 13 ], and the rate of CA-BSI in our study was 1.7% or 1/1,000 catheter days. Symptomatic upper arm DVT requiring additional medical treatment is rare and reported to occur at <4.5% or 2.1 to 3.3/1,000 catheter days [ 12 - 14 ], and symptomatic upper arm DVT in this study occurred at 1.7% or 1/1,000 catheter days, which was lower than that reported in other studies.…”

“…Previous studies reported an average CIT of 4 to 13 days (range, 0-84) [ 5 , 6 , 8 - 10 , 14 ]. However, these studies did not analyze the correlation between the CIT and patient factors.…”

The risk of venous thromboembolism associated with midline catheters compared with peripherally inserted central catheters: A systematic review and meta‐analysis

“…A total of 12 studies were selected for inclusion in this meta‐analysis (Bahl et al.,2019; Benali et al.,2013; Caparas & Hu, 2014; Kaatz et al.,2019; Lisova et al.,2015; Moureau et al.,2002; Seo et al.,2020; Sharma et al.,2018; Sharp et al.,2014; Tso et al.,2017; Xu et al.,2016; Zohourian et al.,2019), with nine studies from the United States, accounting for 75.00%, and one study each from Australia (Sharp et al.,2014), Canada (Benali et al.,2013) and the Czech Republic (Lisova et al.,2015). Three studies were abstracts of meetings (Benali et al.,2013; Kaatz et al.,2019; Sharma et al.,2018).…”

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

“…9,15,16 Multiple studies have indicated support for the safety profile of the MC while acknowledging that further study is needed. 4,5,12,13,34,39,[43][44][45] The MC, with enhancements to catheter characteristics and design, would appear to fill a very important niche in infusion therapy. Initially, 2 priority research questions for MC use were whether MCs were associated with higher complication rates than CVCs (particularly PICCs) and whether MCs could be safely used to administer vancomycin (pH < 5).…”