Making the Most of Midlines

Abstract

Decision-making for vascular access device selection is becoming increasingly complex as new technologies come to market and efforts to reduce central line-associated bloodstream infections increase. This retrospective review of 165 midline catheter outcomes was undertaken after a cluster of unexpected failures occurred in a large academic medical center in the southeastern United States. Mean dwell time for midline catheters was 8.5 days; 62.8% lasted to therapy completion, and complications occurred in 15.8%. A quality improvement initiative including implementation of a blood return algorithm and standard education for unit staff reduced infiltration and thrombosis complications.

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

“…Another factor supporting the view that the MCL is a safe catheter is the lack of cases of phlebitis observed in the present study, a complication that has been reported elsewhere (Caparas & Hung, 2017; Dumont et al, 2014; Meyer, 2020; Penoyer et al,2021; Sharp et al, 2014; Spiegel et al, 2020; Xu et al, 2016). Factors that may have contributed to the lack of phlebitis and infiltration include the use of an ultrasound‐guided MST, the insertion in deep veins of the arm (with a larger diameter and flow allowing a greater haemodilution) (Adams et al, 2016; Alexandrou et al, 2011; Caparas & Hung, 2017), the catheter material and length, the selection of the basilic and brachial veins rather than the cephalic vein, the site of insertion (ZIM TM green zone) (Dawson, 2011) and the use of a sutureless securement device.…”

“…The incidence of thrombosis was lower than that found in other studies (Bahl et al, 2019;Campagna et al,2018; Klungboonkrong et al, 2015;Lisova et al, 2018;Meyer, 2020;Ruggles, & Ventura, 2016;Sharp et al, 2014;Warrington et al, 2012;Xu et al, 2016). Although previous research seems to indicate that placing the catheter tip beyond the axilla may not be safe due to a high risk of thrombosis (Gorski & Czaplewski, 2004;Moureau et al, 2015), the results of our study provide evidence for the safety of the subclavian location.…”

“…The rate of catheter occlusion was lower than that reported by other authors (Campagna et al, 2018;Chopra et al, 2019;Elia et al, 2012;Fabiani et al, 2020;Giuliani et al, 2013;Meyer, 2020;Penoyer et al, 2021;Sharp et al, 2014). Occlusion might be associated with the use of some antibiotics classified as irritants (e.g., vancomycin) (Lam et al, 2018;Smith et al, 2017), but also with drug precipitation, residue build-up or insufficient flushing of the catheter (Goossens, 2015).…”

“…There is a paucity of studies focusing on MCLs, most of them not very recent (Intravenous Nurses Society, 1997;National Association of Vascular Access Networks, 1998;Segatore et al, 1998). Several scientific publications have reported results for catheters inserted in the axillary region (Adams et al, 2016;Caparas & Hu, 2014;Cummings et al, 2011;Fabiani et al, 2020;Hogle et al, 2020;Meyer, 2020;Mushtaq et al, 2018;Penoyer et al, 2021;Warrington et al, 2012), but to the best of our knowledge, there are no data on devices placed in the midclavicular region.…”

Implementing a Midline Catheter Program in an Acute Care Hospital

“…Recently, it was reported that in a small sample of 17 midline catheters, 90% experienced loss of blood return in a mean of 3 days. 23 Blood return was reestablished in 5 of the catheters using a troubleshooting algorithm that could be considered in other organizations.…”