Ultrasound-guided placement of midline catheters in the surgical intensive care unit: a cost-effective proposal for timely central line removal

Deutsch, Gary B.; Sathyanarayana, Sandeep Anantha; Singh, Narendra; Nicastro, Jeffrey

doi:10.1016/j.jss.2013.03.047

Cited by 32 publications

(60 citation statements)

References 11 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%

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%

The clinical performance of midline catheters—An observational study

Madsen

Sloth

Illum

et al. 2019

Acta Anaesthesiol Scand

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“…7,12 While there is a paucity of information that directly compares PICCs to midlines, some data suggest a lower risk of bloodstream infection and thrombosis associated with the latter. [24][25][26] For example, at one quaternary teaching hospital, house staff who are trained to insert midline catheters under ultrasound guidance in critically ill patients with difficult venous access reported no CLABSI and DVT events. 26 Interestingly, multilumen catheters were used twice as often as single lumen catheters in patients with short-term PICCs.…”

Section: Discussionmentioning

confidence: 99%

Patterns and Predictors of Short‐Term Peripherally Inserted Central Catheter Use: A Multicenter Prospective Cohort Study

Paje

Conlon

Kaatz

et al. 2018

Journal of Hospital Medicine

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“…Midlines are an excellent mode of venous access that, like central lines, can deliver large-volume fluids and can be placed for up to 4 weeks at a time. 9 , 10 , 12 With a bloodstream infection rate of only 0.3%, they are much safer and less complicated than central lines. 14…”

Section: Discussionmentioning

confidence: 99%

“…They are between 3 and 10 inches in length (8–25 cm), and their tips reside distal to the axillary vein. 8 , 9 These catheters are termed “midlines” because they are longer than peripheral IV catheters, which are generally 1–3 inches long, and shorter than peripherally inserted central catheters (PICCs), which extend into the vena cava. Several studies have demonstrated that central line use can be decreased by the use of midline catheters.…”

Section: Introductionmentioning

confidence: 99%

A vascular access and midlines program can decrease hospital-acquired central line-associated bloodstream infections and cost to a community-based hospital

Pathak¹,

Gangina²,

Jairam³

et al. 2018

TCRM

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BackgroundWe propose that substituting central lines with midlines can help reduce the total number of central line catheter-days as well as central line-associated bloodstream infections (CLABSIs), thereby reducing the associated costs and the resulting increased length of stay. A midline or vascular access program in a community hospital can bring about these positive changes.ObjectivesOur objective is to evaluate whether the institution of a midline program for vascular access at a community hospital can reduce the number of central line catheter-days and the associated CLABSI rate, incidence, and cost.Materials and methodsWe collected data on the number of central line catheter-days per year starting from 2012. We also collected data on the total number of patient-days during this period and the number of CLABSIs. We started Centers for Disease Control and Prevention (CDC)-based recommendations to help decrease CLABSIs in June 2014; this included the use of the central venous catheters (CVC) insertion bundles and CVC maintenance bundle. Chlorhexidine baths were also given to all patients with central lines. In June 2015, we started a midline program and tracked data till June 2017. We then compared the infection rates during these periods.ResultsWe conclude that instituting CDC recommendations to decrease CLABSIs did bring down the CLABSI rate; this decrease was not statistically significant. However, the addition of the midline program to replace central lines whenever possible, combined with universal CDC recommendations, did result in a significant decrease in both the number of central line days per patient-day and the CLABSI rate.ConclusionWe recommend hospitals to develop a midline program to help reduce the use of central line catheters when possible to reduce the total number of catheter-days and the CLABSI rate associated with them.

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Ultrasound-guided placement of midline catheters in the surgical intensive care unit: a cost-effective proposal for timely central line removal

Cited by 32 publications

References 11 publications

The clinical performance of midline catheters—An observational study

The clinical performance of midline catheters—An observational study

Patterns and Predictors of Short‐Term Peripherally Inserted Central Catheter Use: A Multicenter Prospective Cohort Study

A vascular access and midlines program can decrease hospital-acquired central line-associated bloodstream infections and cost to a community-based hospital

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