The efficacy of midline catheters—a prospective, randomized, active-controlled study

Abstract

This study was performed to investigate whether an intravenous (IV) strategy based on newgeneration midline catheters is an efficacious alternative to a conventional IV strategy consisting of peripheral venous catheters and central venous catheters, for patients needing IV therapy exceeding 5 days. Methods: This was a prospective, randomized, controlled study. Patients requiring more than 5 days of IV treatment were randomized to either a midline catheter-based IV strategy or a conventional strategy. The primary endpoint was the composite of the insertion of a central venous catheter (CVC) or the need for four or more peripheral venous catheter (PVC) insertions. The secondary outcomes included catheter dwell times and reasons for premature removal. Results: One hundred and twenty patients were included. The fraction of patients receiving four or more PVCs or having a CVC inserted was 12/58 (21%) in the midline group versus 38/58 (66%) in the conventional group (p < 0.001); the number needed to treat was 2.2. The median overall catheter dwell time was 7 days (range 0-60 days) in the midline group and 4 days (range 0-84 days) in the conventional group (p = 0.002). Conclusion:In patients requiring more than 5 days of IV therapy, a midline catheter strategy reduced the need for insertion of a CVC or four or more PVCs.

Efficacy and Safety of Midline Catheters with Integrated Wire Accelerated Seldinger Technique

“…This may be owing to the short length of the catheter, and the fixture consists of a simple sticker, allowing easy and inadvertent extrusion. The adverse events in this study accounted for 27.4% (16.2/1,000 catheter days), which was higher than the average complication rate of 10% (11-65.7/1,000 catheter days) reported [ 8 - 10 ]. This may be because the scope of adverse events was wider in this study.…”

“…In this study, however, the rate of major complication such as CA-BSI and symptomatic DVT was low (2.6%). CA-BSIs are reported to occur at <0.2% to 2.0% or 0.1 to 0.2/1,000 catheter days [ 5 , 8 - 13 ], and the rate of CA-BSI in our study was 1.7% or 1/1,000 catheter days. Symptomatic upper arm DVT requiring additional medical treatment is rare and reported to occur at <4.5% or 2.1 to 3.3/1,000 catheter days [ 12 - 14 ], and symptomatic upper arm DVT in this study occurred at 1.7% or 1/1,000 catheter days, which was lower than that reported in other studies.…”

“…Previous studies reported an average CIT of 4 to 13 days (range, 0-84) [ 5 , 6 , 8 - 10 , 14 ]. However, these studies did not analyze the correlation between the CIT and patient factors.…”

A Meta-Analysis of Incidence of Catheter-Related Bloodstream Infection with Midline Catheters and Peripherally Inserted Central Catheters

“…Medium-length catheter is also called midline catheter (MC), the catheter length is 20-30 cm, and the catheter is inserted into the important vein, cephalic vein, or brachial vein from the upper arm through conventional puncture of the upper and lower fingers at the elbow fossa or ultrasound-guided technology. e tip of the catheter is located in the thoracic segment of the axillary vein or may reach the subclavian vein [6,7]. e 2015 standard of nursing practice for intravenous infusion therapy of Infusion Nurses Society (INS) recommends that all drugs and fluids that can pass through peripheral superficial venous devices be used for medium-length catheters [8].…”

Does the Midline Peripheral Intravenous Catheter Have a Place in Critical Care?

“…9,15,32,34 Because the distal tip of the MC is located in peripheral vasculature, most references recommend limiting MC use to infusions that are appropriate for peripheral vascular administration. 7,8,19,23,[25][26][27]35 Criteria for osmolarity and pH limits that are safe for peripheral vascular administration, however, are uncertain. 14 Multiple factors fostered the push to improve the efficacy of the MC and the resultant acceleration in use.…”