August 17, 2022
Midline Catheters vs. Peripherally Inserted Central Catheters: Patient Safety and OutcomesBy Daniel Mendoza, MD
Peripherally inserted central catheters (PICCs) and midlines are commonly used in hospitalized patients, though it is unclear whether one is safer than the other.
Swaminathan et al. conducted a retrospective study 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. The authors analyzed data from a multihospital registry including patients hospitalized from December 2017 through January 2020 who had a PICC or midline placement. The main outcome was 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 were used to estimate risk for major complications.
The authors evaluated data on 5,758 patients with PICCs and 5,105 with midlines (median [IQR] age of participants, 64.8 [53.4-75.4] years; 5,741 [52.8%] were female). After the authors adjusted for patient characteristics, comorbidities, catheter lumens, and dwell time, the data showed that patients who received PICCs had a greater risk of developing a major complication compared with those who received midlines (odds ratio, 1.99; 95% confidence interval [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 was found. In time-to-event models, similar outcomes for bloodstream infection and catheter occlusion were also noted; however, the risk of DVT was lower in patients who received PICCs vs. midlines (hazard ratio, 0.53; 95% CI, 0.38-0.74).
In conclusion, midlines were associated with a lower risk of bloodstream infection and occlusion compared with PICCs. It is unclear whether DVT risk is similar or greater with midlines compared with PICCs. This study favors using midlines for intravenous antibiotics; however, randomized clinical trials are needed to confirm the findings.
