Experience in the use of midclavicular catheters: An inception cohort study

Abstract

Aims and objectives:To describe the outcomes of midclavicular catheters related to first insertion success rate, catheter dwell time, rate of catheter survival until the end of the treatment, and complication rates, as well as identify risk factors associated with early catheter removal.Background: Midclavicular catheters are peripheral venous catheters that are typically 20-25 cm in length.Design: Inception cohort study. Methods:We included all the midclavicular lines inserted in patients who met any of the following criteria: (a) difficult venous access; (b) administration of intravenous therapy expected to last between 6 and 30 days with non-irritant (pH=5-9) and/or non-vesicant drugs; or (c) contraindications to central venous catheter placement. The incidence of adverse events was calculated using percentages and episodes per 1,000 catheter days.Univariate and multivariate logistic regression analyses were performed to identify significant risk factors for unexpected catheter removal by calculating odds ratios. Catheter survival was assessed using Cox regression analysis. The STROBE guidelines were followed.Results: Overall, 2,275 midclavicular lines were placed in 1,841 participants. The insertion success rate was 99.4% and the mean catheter dwell time was 21.82 days.The rate of adverse events was .7 per 1,000 catheter days, the most common complications being thrombosis (.39) and catheter-associated bacteraemia (.14). No significant association was found between adverse events and the administration of irritant drugs. The incidence of unexpected removal was 6.7 per 1,000 catheter days. The multivariate analysis showed that both age ≤70 years and home therapy were associated with a lower likelihood of catheter failure.Conclusions: Midclavicular catheters are associated with a high rate of insertion success and low rates of adverse events and unplanned removal.Relevance to clinical practice.

The First Use of a Midline Catheter in Outpatient Pain Management

“…Currently, the scientific debate revolves around the proper location of the catheter tip, i.e., in the so-called axillary or "midclavicular" line [1,5]. In any case, the proper position of the catheter tip must be chosen in such a way as to prevent mechanical complications and thrombosis associated with the presence of a vascular catheter [1,5,6]. Unlike central access, the insertion of MCs does not require the confirmation of proper positioning on an X-ray, which facilitates the use of this type of access in outpatient practice [1].…”