Midline Catheters: Could They Replace a Central Vascular Access Device?

Area of Science:

• Vascular Access Devices
• Infusion Therapy
• Patient Safety

Background:

• Midline catheter use has increased significantly over 30 years.
• Providers aim to reduce central line-associated bloodstream infections (CLABSIs) by using midline catheters.
• Vessel preservation necessitates addressing all vascular access device (VAD)-associated complications, not just CLABSIs.

Purpose of the Study:

• To review existing studies on midline catheter use as a substitute for central venous catheters.
• To evaluate the evidence supporting the shift from central venous catheters to midline catheters.
• To identify gaps in current research regarding midline catheter appropriateness and safety.

Main Methods:

• Review of existing literature on midline catheter studies.
• Evaluation of evidence regarding the substitution of midline catheters for central venous catheters.
• Analysis of methodological issues in current studies, including outcome definitions and study designs.

Main Results:

• Significant confusion persists regarding appropriate midline catheter tip location and infusible fluids/medications.
• Current studies often mix defined complications with symptoms and rely on retrospective data.
• Evidence supporting a major practice change to midline catheters is currently insufficient.

Conclusions:

• While midline catheters may suit some patients, higher-level evidence is required.
• Further research is needed to establish evidence-based guidelines for midline catheter use.
• Current evidence does not fully support widespread substitution of central venous catheters with midline catheters.