Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2022 Jan 1;182(1):50-58.
doi: 10.1001/jamainternmed.2021.6844.

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

Lakshmi Swaminathan  1 , Scott Flanders  2   3 , Jennifer Horowitz  2   3 , Qisu Zhang  2   3 , Megan O'Malley  2   3 , Vineet Chopra  2   3   4
Affiliations
Meta-Analysis

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

Lakshmi Swaminathan et al. JAMA Intern Med. .

Abstract

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 participants: This 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 relevance: In 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.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Dr Flanders reported receiving grants to institution from Blue Cross Blue Shield of Michigan (BCBSM) during the conduct of the study. Dr O’Malley reported receiving grants from BCBSM and Blue Care Network as part of the BCBSM Value Partnerships program during the conduct of the study. Dr Chopra reported receiving grants from Blue Cross Blue Shield/Blue Care Network (the work of the Michigan Hospital Medicine Safety Consortium is supported by BCBSM) and Agency for Healthcare Research and Quality (1-R18-HS025891) during the conduct of the study. No other disclosures were reported.

Figures

Figure.
Figure.. Sample Selection
IV indicates intravenous; MC, midline catheter; PICC, peripherally inserted central catheter.
See this image and copyright information in PMC

Comment in

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Magill SS, Edwards JR, Bamberg W, et al. ; Emerging Infections Program Healthcare-Associated Infections and Antimicrobial Use Prevalence Survey Team . Multistate point-prevalence survey of health care-associated infections. N Engl J Med. 2014;370(13):1198-1208. doi:10.1056/NEJMoa1306801 - DOI - PMC - PubMed
    1. Galen B, Baron S, Young S, Hall A, Berger-Spivack L, Southern W. Reducing peripherally inserted central catheters and midline catheters by training nurses in ultrasound-guided peripheral intravenous catheter placement. BMJ Qual Saf. 2020;29(3):245-249. doi:10.1136/bmjqs-2019-009923 - DOI - PubMed
    1. Adams DZ, Little A, Vinsant C, Khandelwal S. The midline catheter: a clinical review. J Emerg Med. 2016;51(3):252-258. doi:10.1016/j.jemermed.2016.05.029 - DOI - PubMed
    1. Seo H, Altshuler D, Dubrovskaya Y, et al. . The safety of midline catheters for intravenous therapy at a large academic medical center. Ann Pharmacother. 2020;54(3):232-238. doi:10.1177/1060028019878794 - DOI - PubMed
    1. Chopra V, Anand S, Krein SL, Chenoweth C, Saint S. Bloodstream infection, venous thrombosis, and peripherally inserted central catheters: reappraising the evidence. Am J Med. 2012;125(8):733-741. doi:10.1016/j.amjmed.2012.04.010 - DOI - PubMed

Publication types