Clinical question: Are midline catheters safer than peripherally inserted central catheters (PICCs)?
Background: The use of midline catheters instead of PICCs has grown, but evidence of their comparative safety is inconclusive.
Study design: Observational cohort study
Setting: 48 hospitals in Michigan
Synopsis: Multi-hospital registry data were examined for 5,758 patients with PICCs and 5,105 with midlines placed for either difficult venous access or short-term intravenous antibiotics. PICCs were more likely than midlines to be associated with a composite of major complications (OR 1.99; 95% CI, 1.61-2.47). Specifically, PICCs had higher rates of catheter occlusion (7% versus 2.1%; P<0.001) and bloodstream infection (1.6% versus 0.4%; P<0.001) than midlines, but a similar rate of VTE. However, in time-to-event models, midlines had a greater daily hazard of DVT than PICCs.
Bottom line: Compared to patients with midlines, patients with PICCs were nearly twice as likely to experience a major complication.
Citation: Swaminathan L, et al. Safety and outcomes of midline catheters vs peripherally inserted central catheters for patients with short-term indications: a multicenter study. JAMA Intern Med. 2022;182(1):50–58.
Dr. Indovina is a hospitalist at Denver Health, Denver and an assistant professor in the division of internal medicine, University of Colorado School of Medicine.