Safety and utilization of peripherally inserted central catheters versus midline catheters at a large academic medical center

Xu, Tianyuan; Kingsley, Lawrence A.; DiNucci, Susan; Messer, Gwen; Jeong, Jong‐Hyeon; Morgan, Brian B.; Shutt, Kathleen A.; Yassin, Mohamed

doi:10.1016/j.ajic.2016.09.010

Cited by 65 publications

(85 citation statements)

References 17 publications

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“…In regard to infection and catheter clots, other studies have reported similar frequencies or incidences causing catheter removal . Only a single catheter in the current study was suspect of causing bloodstream infection as indicated by an increase in C‐reactive protein, but subsequent examination for the presence of bacteria on the catheter yielded negative results.…”

Section: Discussionsupporting

confidence: 52%

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: 52%

The clinical performance of midline catheters—An observational study

Madsen

Sloth

Illum

et al. 2019

Acta Anaesthesiol Scand

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“…In a study conducted by Xu et al (2016) researchers aimed to compare the utilization and safety of PICCs compared to MCs. This retrospective study was performed at a large academic medical center.…”

Section: Midline Cathetersmentioning

confidence: 99%

“…The study sample included 200 MCs and 206 PICCs placed throughout varying inpatient care areas of the facility. Researchers used the electronic health record to collected length of stay, VAD dwell time, complications, comorbidity score, demographics, and insertion site (Xu et al, 2016).…”

Section: Midline Cathetersmentioning

confidence: 99%

“…PICC line infections were defined using the CDC criteria (CDC, 2019) and MC infections by positive blood culture or gross site infection. Analysis of data was performed using the SAS 9.3 statistical package, the Kruskal-Wallis test to explore differences between groups, and Fisher exact test to explain strength of association for categorical variables (Xu et al, 2016).…”

Section: Midline Cathetersmentioning

confidence: 99%

“…From a total of 367 patients, 172 had a MC only, 185 had a PICC only, and 10 had both a PICC and MC during the same single admission (Xu et al, 2016). Findings included 12 total complications associated with PICCs, 10 were serious complications including phlebitis, infection, DVT, and positive culture requiring readmission and two were not considered serious and related to nonpatency.…”

Section: Midline Cathetersmentioning

confidence: 99%

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Appropriateness of Vascular Access Device Selection

Viveiros¹

2019

Preprint

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Central venous access devices (CVADs) are associated with serious complications, including central line associated bloodstream infection (CLABSI), that place patients at risk for poor outcomes and are costly for hospital systems. Research suggests great variability of CVAD use in hospitals including overuse and inappropriate use of these devices which places patients at unnecessary risk for complications. Each unique patient situation involves multiple characteristics that adds complexity to their hospitalization. Clinicians make decisions regarding line selection often during emergent situations without the appropriate level of evidence to support this decision, which results in inconsistencies and variations in the use of CVADs. Vascular access nurses, specialized clinicians who place and maintain vascular access devices (VADs) in hospitalized patients, are often involved in decision making regarding VAD use. Providing these specialized clinicians with the latest evidence-based decision support tools and the knowledge needed to interpret this information to determine the most appropriate VAD for an individual patient may impact VAD utilization. Empowering vascular access nurses to appropriately evaluate and decide if a patient meets the criteria for CVAD insertion prior to placement could prevent unnecessary exposure to potentially dangerous and costly complications. The proposed project objectives include introducing an evidence-based guideline for use by the vascular access team to support VAD selection for hospitalized adult patients at a large academic medical center. Decision support guidelines are composed of evidence-based recommendations from Michigan Appropriateness Guide for Intravenous Catheters (MAGIC) resources. The algorithms to be implemented address various complex patient scenarios that challenge clinicians when choosing the most appropriate VAD. Project goals include improving appropriateness of VAD selection through recommendations from vascular access nurses using MAGIC resources as evidence-based guidelines in clinical decision making. Achieving these goals may result in a decrease in inpatient CVAD use and a reduction in serious complications associated with CVADs. Objectives are aimed at improving the quality of patient care by using the latest evidence for vascular access recommendations. Improved quality of care can reduce health care costs by preventing serious and life-threatening complications that prolong the hospital length of stay and require additional unnecessary therapies and hospital readmissions.

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Safety and Outcomes of Midline Catheters vs Peripherally Inserted Central Catheters for Patients With Short-term Indications

et al. 2022

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IMPORTANCE Peripherally inserted central catheters (PICCs) and midlines are frequently used for short-term venous access; whether one is safer than the other in this setting has not been adequately reported.OBJECTIVE To compare outcomes between patients who had a PICC vs midline placed for the indication of difficult vascular access or antibiotic therapy for 30 or fewer days. DESIGN, SETTING, AND PARTICIPANTSThis cohort study analyzed data from a multihospital registry including patients admitted to a participating site from December 2017 through January 2020 who had a PICC or midline placement for the indications of difficult venous access or intravenous antibiotic therapy prescribed for 30 or fewer days. Data were analyzed from October 2020 to March 2021. EXPOSURES PICC and midline placement.MAIN OUTCOMES AND MEASURES Major complications, including a composite of symptomatic catheter-associated deep vein thrombosis (DVT), catheter-related bloodstream infection, and catheter occlusion. Logistic regression and Cox proportional hazards regression models (taking into account catheter dwell) were used to estimate risk for major complications, adjusting for patient and device characteristics and the clustered nature of the data. Sensitivity analyses limiting analyses to 10 days of device dwell were performed.RESULTS Data on 10 863 patients, 5758 with PICCs and 5105 with midlines (median [IQR] age of device recipients, 64.8 [53.4-75.4] years; 5741 [52.8%] were female), were included. After adjusting for patient characteristics, comorbidities, catheter lumens, and dwell time in logit models, patients who received PICCs had a greater risk of developing a major complication compared with those who received midlines (odds ratio, 1.99; 95% CI, 1.61-2.47). Reduction in complications stemmed from lower rates of occlusion (2.1% vs 7.0%; P < .001) and bloodstream infection (0.4% vs 1.6%; P < .001) in midlines vs PICCs; no significant difference in the risk of DVT between PICCs and midlines was observed. In time-to-event models, similar outcomes for bloodstream infection and catheter occlusion were noted; however, the risk of DVT events was lower in patients who received PICCs vs midlines (hazard ratio, 0.53; 95% CI, 0.38-0.74). Results were robust to sensitivity analyses. CONCLUSIONS AND RELEVANCEIn this cohort study among patients with placement of midline catheters vs PICCs for short-term indications, midlines were associated with a lower risk of bloodstream infection and occlusion compared with PICCs. Whether DVT risk is similar or greater with midlines compared with PICCs for short-term use is unclear. Randomized clinical trials comparing these devices for this indication are needed.

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Safety and utilization of peripherally inserted central catheters versus midline catheters at a large academic medical center

Cited by 65 publications

References 17 publications

The clinical performance of midline catheters—An observational study

The clinical performance of midline catheters—An observational study

Appropriateness of Vascular Access Device Selection

Safety and Outcomes of Midline Catheters vs Peripherally Inserted Central Catheters for Patients With Short-term Indications

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