Midline catheters: A 3-year experience at a veterans administration medical center

Journal: American Journal of Infection Control

Publication Date: 2023

Objective: To evaluate the effectiveness and safety of midline catheters (MC).

Methods: Retrospective data collection of midline catheter insertions at a Veterans Affairs Medical Center from 2016 to 2019. The primary outcome was the completion of intended therapy; secondary outcomes included catheter-related complications, both major (e.g., catheter-related bloodstream infection [CRBSI] or venous thromboembolism [VTE]) and minor (e.g., catheter occlusion, kinking, dislodgement).

Results: Of the midline catheters, 53.9% (62 cases) were used for antibiotic infusion, 32.6% (49 cases) for difficult vascular access, with a median dwell time of 11 days. 80.9% (93 cases) of the midline catheters remained in place until the completion of therapy.

Conclusion: Midline catheters are effective and safe for patients requiring peripheral-compatible infusions.

Study Background

Midline catheters have become an alternative to peripherally inserted central catheters (PICC) when peripheral-compatible infusions are needed.

A recent large multi-institutional cohort study focusing on midline catheters inserted for up to 30 days due to difficult vascular access or intravenous antibiotic therapy indications showed lower rates of CRBSI and catheter occlusion compared to PICCs.

Current guidelines recommend the use of midline catheters if the expected duration is no more than 14 days and there is no indication for central venous access.

Methods

Design: Retrospective study

Period: June 2016 to May 2019

Location: Veterans Affairs Ann Arbor Healthcare System

Participants: Veterans

Data Collection: Included clinical indications for midline catheter insertion, catheter dwell time, therapy completion time, and catheter-related complications.

Results

A total of 115 midline catheters were inserted, with 93 completing the intended therapy.

Departments Involved: General wards, intensive care units, post-acute care units

Indications for Insertion: Antibiotic infusion, difficult vascular access

Insertion Sites: Primarily basilic vein (61.7%), followed by brachial vein (25.2%)

Medications Used: Piperacillin-tazobactam, ceftriaxone, ertapenem, daptomycin, cefazolin, vancomycin, ampicillin-sulbactam, cefepime

Dwell Time: Median dwell time was 11 days, with 41 patients (35.6%) having a dwell time exceeding 14 days

Major Complications: 1 case of non-occlusive deep vein thrombosis (DVT)

Minor Complications: 27 cases (catheter dislodgement, kinking, occlusion, etc.)

Conclusion

Midline catheters are effective and safe for patients requiring short to mid-term peripheral-compatible infusions across various clinical care settings, including general wards, intensive care units, and post-acute care units.

Outlook

Summarizing three years of midline catheter use: Over 80% of patients completed the intended therapy, with most catheters removed within 14 days. More than one-third had longer dwell times, with a low incidence of complications, mostly minor. Thus, midline catheters significantly contribute to vascular protection and the prevention of major complications.

Antibiotic infusion is the most common reason for midline catheter placement, supporting their use as the first choice for short to mid-term peripheral-compatible drug therapy.

Optimizing clinical practice strategies for midline catheter insertion can further improve clinical outcomes, particularly in reducing the risk of minor complications.