Clinical

Evaluating complications of midline catheters


 

Background: Midline catheters have gained popularity in inpatient medical settings as a convenient alternative to PICC lines. This is primarily because of the ability to avoid central line–associated bloodstream infections (CLABSI) since these catheters terminate in the peripheral veins and cannot be reported as such. Additionally, they are potentially able to dwell longer than are traditional peripheral intravenous catheters. However, insufficient data exist to accurately describe the rate of complications in these catheters, as prior studies are based on single-center experiences.

Dr. Yasmin Marcantonio of the Division of Hospital Medicine, Duke University Health System, Durham, NC

Dr. Yasmin Marcantonio


Study design: Multicenter prospective cohort study.

Setting: Hospital medicine ward or medical ICU.

Synopsis: With use of a large database of adult patients from a quality initiative supported by Blue Cross Blue Shield of Michigan and Blue Care Network, this study identified 1,161 patients who had midline catheters placed and showed a 10.3% complication rate, of which 66.7% were minor (dislodgment, leaking, infiltration, or superficial thrombophlebitis) rather than major complications (occlusion, symptomatic upper-extremity deep venous thrombosis, or bloodstream infection). However, a similar rate of removal of the catheters was reported for major and minor complications (53.8% vs. 52.5%; P = .90). Across sites, there was substantial variation in utilization rates (0.97%-12.92%; P less than .001), dwell time and indication for use, and complication rates (3.4%-16.7%; P = .07).

The article does not provide guidance on when and how midline catheters should be used in order to minimize risk; nor does it include a comparison with traditional peripheral intravenous catheters or with PICC lines. Further studies are needed to guide indications and practices for catheter placement in order to minimize risk. Providers should continue to carefully consider the risks and benefits of midline catheter placement in individual cases.

Bottom line: Midline catheter placement more commonly leads to minor rather than major complications, though patterns of use and outcomes vary substantially across sites.

Citation: Chopra V et al. Variation in use and outcomes related to midline catheters: results from a multicentre pilot study. BMJ Qual Saf. 2019 Mar 18. doi: 10.1136/bmjqs-2018-008554.

Dr. Marcantonio is a Med-Peds hospitalist at Duke University Health System.

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