The Utility of Midline Intravenous Catheters in Critically Ill Emergency Department Patients

Spiegel, Rory; Eraso, Daniel; Leibner, Evan; Thode, Henry C.; Morley, Eric J.; Weingart, Scott D.

doi:10.1016/j.annemergmed.2019.09.018

Cited by 22 publications

(25 citation statements)

References 19 publications

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“…A mean of 1.17 attempts per catheter were needed to achieve insertion, somewhat lower than the figures reported in other studies (Deutsch et al, 2014;Lisova et al, 2018;Scoppettuolo et al, 2016;Spiegel et al, 2020). This result is promising since, in clinical practice, it is extremely important to achieve successful catheter placement with as few attempts as possible and thereby minimize patient suffering (Morrell, 2020).…”

Section: Discussionmentioning

confidence: 73%

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

Tomás-López

Cristóbal-Domínguez

Báez-Gurruchaga

et al. 2021

Journal of Clinical Nursing

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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.

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Section: Discussionmentioning

confidence: 73%

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

Tomás-López

Cristóbal-Domínguez

Báez-Gurruchaga

et al. 2021

Journal of Clinical Nursing

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“…When assessing catheter failure by catheter length, the longer 2.5 inch catheter was less likely to experience failure than the shorter 1.88 inch catheter. While the impact of IV length on catheter failure has not previously been specifically evaluated in the setting of vesicant usage, most studies only describe short-term (less than 24 hours) infusions of vesicants with standard length PIVCs compared to longer infusion durations with longer peripheral midline catheters suggesting a benefit of longer catheters [ 21 , 22 ].…”

Section: Discussionmentioning

confidence: 99%

Vesicant infusates are not associated with ultrasound-guided peripheral intravenous catheter failure: A secondary analysis of existing data

2022

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Background Intravenous vesicants are commonly infused via peripheral intravenous catheters (PIVC) despite guidelines recommending administration via central route. The impact of these medications on PIVC failure is unclear. We aimed to assess dose-related impact of these caustic medications on ultrasound-guided (US) PIVC survivorship. Methods We performed a secondary analysis of a randomized control trial that compared survival of two catheters: a standard long (SL) and an ultra-long (UL) US PIVC. This study involved reviewing and recording all vesicants infusions through the PIVCs. Type and number of vesicants doses were extracted and characterized as one, two or multiple. The most commonly used vesicants were individually categorized for further analysis. The primary outcome was PIVC failure accounting for use and timing of vesicant infusates. Results Between October 2018 and March 2019, 257 subjects were randomized with 131 in the UL group and 126 in the SL group. Vesicants were infused in 96 (37.4%) out of 257 study participants. In multivariable time-dependent extended Cox regression analysis, there was no significant increased risk of failure due to vesicant use [adjusted hazard ratio, aHR 1.71 (95% CI 0.76–1.81) p = 0.477]. The number of vesicant doses was not significantly associated with the increased risk of PIVC failure [(1 vs 0) aHR 1.20 (95% CI 0.71–2.02) p = 0.500], [(2 vs 0) aHR 1.51 (95% CI 0.67–3.43) p = 0.320] and [(≥ 3 vs 0) aHR 0.98 (95% CI 0.50–1.92) p = 0.952]. Conclusion Vesicant usage did not significantly increase the risk of PIVC failure even when multiple doses were needed in this investigation. Ultrasound-guided PIVCs represent a pragmatic option when vesicant therapy is anticipated. Nevertheless, it is notable that overall PIVC failure rates remain high and other safety events related to vesicant use should be considered when clinicians make vascular access decisions for patients.

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“…As facilities expanded the use of the MC, research continued to challenge conservative criteria for peripheral administration. In a prospective, observational case series, Spiegel et al 51 described their experience with MC use in critically ill patients in the emergency department. They found a mean dwell time of 6.7 days, with a 99% placement success rate and a 2.5% insertion-related complication rate.…”

Section: Postulated That the Tip Location Nearer To The Central Circulation May Lead To Usementioning

confidence: 99%

“…They also reported that 29.5% of these MCs were successfully used to administer vasopressors, a criterion previously approved by their facility policy. 51 The requirement to place a CVC for vasopressor administration has been challenged in PIVC-related research. A systematic review by Loubani and Green 52 included 85 studies (primarily case reports) that evaluated peripheral administration of vasopressors.…”

Section: Postulated That the Tip Location Nearer To The Central Circulation May Lead To Usementioning

confidence: 99%

“…The primary concern is the paucity of accurate and reliable MC-related outcomes by which to measure the impact of the MC on vascular health and the ability of the MC to effectively provide long-term infusion therapy needs. 14,16,51 Unfortunately, MC-related research studies are often plagued with the limitations common to VAD-related research as a whole: retrospective analyses; single-site studies; small sample sizes; risk of bias; documentation gaps; and wide variability in research methods, VAD-related adverse event definitions, inclusion criteria, and VAD characteristics. 14,18,37,40,[53][54][55] The lack of high-quality VAD-related randomized controlled trials reduces the applicability of research recommendations to guide VAD selection and management.…”

Section: Potential Risks Of Mcsmentioning

confidence: 99%

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

Nickel

2021

Critical Care Nurse

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Background The goals of infusion therapy are to preserve vascular health and safely deliver needed treatment. Achieving these goals is challenging in critical care because of the complexity of the treatment required. Daily justification of retaining an existing central venous catheter also creates urgency to change to a peripheral vascular access device. The midline catheter has had a resurgence in use because of the need for a long-term peripheral vascular access device not linked to central catheter–associated bloodstream infection risk. Objective To review the characteristics of midline catheters, the benefits and risks of midline catheters, and current evidence regarding midline catheter use in critical care. Results Research related to midline catheters has greatly expanded the body of knowledge regarding vascular access device selection and midline catheter use. Discussion Although the quality and results of research on vascular access devices vary widely, a more accurate safety profile is emerging to illustrate how midline catheter use can support the goals of infusion therapy. Conclusions Optimizing vascular access device selection requires recognition that every vascular access device can cause patient harm. Although the midline catheter appears to fill an important niche in infusion therapy, use of the midline catheter should be carefully evaluated. Midline catheters should not be used as a catheter-associated bloodstream infection prevention strategy, should be inserted to administer peripherally compatible solutions, and should be considered for short-term continuous vesicant therapy only in emergent situations until more definitive vascular access can be achieved.

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The Utility of Midline Intravenous Catheters in Critically Ill Emergency Department Patients

Cited by 22 publications

References 19 publications

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

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

Vesicant infusates are not associated with ultrasound-guided peripheral intravenous catheter failure: A secondary analysis of existing data

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

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