Incidence of Midline Catheter Complications Among Hospitalized Patients

Abstract

The Art and Science of Infusion Nursing BACKGROUND Inpatient use of midline catheters has increased as a strategy to reduce excessive use of central venous access devices (CVADs) and risk of central-line associated bloodstream infections. 1,2 In addition, a midline catheter is recommended for therapy lasting 5 to 14 days, providing a longer catheter dwell time than short peripheral intravenous catheters. Use of midline catheters may remain appropriate for therapy up to 28 days depending on patient vasculature, patient preference, and documented catheter function during use. 3,4 However, the risk of symptomatic catheter-related thrombosis (CRT) with midline catheters (0%-12%) may be similar or higher than CVADs (up to 10%). 5,6 Midline catheters are inserted into basilic, brachial, or cephalic veins and terminate at or below the axilla, with a typical length of 8 to 20 cm. 4 This placement into smaller veins with lower flow rates than central veins may contribute to the risk of CRT observed for midline catheters. 7 To directly address this issue, new device technology has emerged to reduce thrombus accumulation on the surface of the midline ABSTRACTThe use of midline catheters has increased to reduce excessive use of central venous access devices, and additional data on midline catheter complications are needed. This study aimed to describe midline catheter complications among hospitalized patients. This retrospective study included a random sample of 300 hospitalized patients with a midline catheter insertion in 2019. The primary outcome was a composite end point of 8 complications: occlusion, bleeding at insertion site, infiltration/extravasation, catheter-related thrombosis, accidental removal, phlebitis, hematoma, and catheter-related infection. Midline catheter failure was defined as removal prior to the end of therapy due to complications. Among 300 midline catheters, the incidence of the composite end point of 1 or more midline complications was 38% (95% confidence interval, 33%-44%). Complications included occlusion (17.0%), bleeding at insertion site (12.0%), infiltration/extravasation (10.0%), catheter-related thrombosis (4.0%), accidental removal (3.0%), phlebitis (0.3%), hematoma (0.3%), and catheter-related infection (0.3%). Midline catheter failure occurred in 16% of midline catheters (n = 48) due to infiltration/extravasation (n = 27), accidental removal (n = 10), catheter-related thrombosis (n = 9), occlusion (n = 4), and catheter-related infection (n = 1). Three catheters had 2 types of failure. The most common complications of occlusion and bleeding rarely resulted in midline catheter failure. The most common causes of midline catheter failure were infiltration/extravasation, accidental removal, and catheter-related thrombosis.

Peripheral blood stem cell collection: Are midline catheters a viable alternative to central venous catheters?

“…Compared to CVCs, midline catheters have lower risks of catheter related blood stream infection and thrombosis; the risk of thrombophlebitis is lower compared to peripheral catheters 10 . Cited rates for midlines include those of infection: 0.0%–0.3%; phlebitis: 0.3%–1.7%; infiltration or extravasation: 3.5%–10%; and occlusion: 2.6%–17.0% 11,12 . Other risks associated with midlines include erythema at the insertion site, bleeding, and pain 13 .…”

“…10 Cited rates for midlines include those of infection: 0.0%-0.3%; phlebitis: 0.3%-1.7%; infiltration or extravasation: 3.5%-10%; and occlusion: 2.6%-17.0%. 11,12 Other risks associated with midlines include erythema at the insertion site, bleeding, and pain. 13 These complications are spread over an average dwell time for midline catheters of 7.7-16.7 days, 10 which is longer than needed for stem cell collection.…”

Cumplimiento De Practicas Clinicas Basadas en Evidencia Para La Instalacion Y Mantencion De Cateteres Venosos Perifericos en Personas Hospitalizadas

“…Su inserción se ha definido como el procedimiento invasivo más frecuente en todo el mundo y estos presentan una alta tasa de complicaciones asociado al 8% -42%. Dentro de las complicaciones se informan oclusión, sangrado en el sitio de inserción, infiltración y extravasación, trombosis relacionada al catéter, flebitis, retiro accidental e infección (2)(3)(4)(5)(6).…”

Consumer experience and outcomes of insertion, removal, and management practices of short and midline peripheral intravenous catheters in acute health care: a mixed methods systematic review protocol

“…2 Complications may include phlebitis, post-insertion phlebitis, pain, discomfort, occlusion, infiltration, extravasation, thrombosis, nerve injury, or PIVC-related bloodstream infections. 2,9,10 PIVC infection prevention and safety is a concern for patients 2 and the literature is unclear as to what extent patients are monitored for complications, especially post-infusion. In their study, Webster et al found that 75% of patients with post-infusion phlebitis did not initially have phlebitis upon the removal of the PIVC.…”

“…A significant challenge in PIVC management is preventing and dealing with PIVC-related complications, which are costly both to the patient and to the health care system 2 . Complications may include phlebitis, post-insertion phlebitis, pain, discomfort, occlusion, infiltration, extravasation, thrombosis, nerve injury, or PIVC-related bloodstream infections 2,9,10 . PIVC infection prevention and safety is a concern for patients 2 and the literature is unclear as to what extent patients are monitored for complications, especially post-infusion.…”