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Comparing Complication Rates of Midline Catheter vs Peripherally Inserted Central Catheter. A Systematic Review and
Meritxell Urtecho1,2, Victor D Torres Roldan1,2, Tarek Nayfeh1,2
1Mayo Clinic Evidence-based Practice Center, Rochester, Minnesota, USA.
Background:
Peripherally inserted central catheters (PICCs) and midlines are commonly used devices for reliable vascular access. Infection and thrombosis are the main adverse effects of these catheters. We aimed to evaluate the relative risk of complications from midlines and PICCs.
Methods:
We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) and observational studies. The primary outcomes were catheter-related bloodstream infection (CRBSI) and thrombosis. Secondary outcomes evaluated included mortality, failure to complete therapy, catheter occlusion, phlebitis, and catheter fracture. The certainty of evidence was assessed using the GRADE approach.
Results:
Of 8368 citations identified, 20 studies met the eligibility criteria, including 1 RCT and 19 observational studies. Midline use was associated with fewer patients with CRBSI compared with PICCs (odds ratio [OR], 0.24; 95% CI, 0.15-0.38). This association was not observed when we evaluated risk per catheter. No significant association was found between catheters when evaluating risk of localized thrombosis and pulmonary embolism. A subgroup analysis based on location of thrombosis showed higher rates of superficial venous thrombosis in patients using midlines (OR, 2.30; 95% CI, 1.48-3.57). We did not identify any significant difference between midlines and PICCs for the secondary outcomes.
Conclusions:
Our findings suggest that patients who use midlines might experience fewer CRBSIs than those who use PICCs. However, the use of midline catheters was associated with greater risk of superficial vein thrombosis. These findings can help guide future cost-benefit analyses and direct comparative RCTs to further characterize the efficacy and risks of PICCs vs midline catheters.
Insights
Midline catheters may reduce catheter-related bloodstream infections (CRBSI) compared to peripherally inserted central catheters (PICCs). However, midlines increase the risk of superficial vein thrombosis, warranting careful consideration of these vascular access devices.
Area of Science:
- Vascular Access Devices
- Infectious Diseases
- Thrombosis
Background:
- Peripherally inserted central catheters (PICCs) and midlines are crucial for vascular access.
- Catheter-related bloodstream infection (CRBSI) and thrombosis are primary complications.
- Evaluating the comparative risks of midlines versus PICCs is essential.
Purpose of the Study:
- To systematically review and meta-analyze the relative risk of complications associated with midline catheters compared to PICCs.
- To compare rates of CRBSI, thrombosis, mortality, and other adverse events.
- To inform clinical decision-making and future research on vascular access devices.
Main Methods:
- Systematic review and meta-analysis of randomized controlled trials (RCTs) and observational studies.
- Primary outcomes included CRBSI and thrombosis; secondary outcomes included mortality, treatment completion, occlusion, phlebitis, and catheter fracture.
- Certainty of evidence assessed using the GRADE approach.
Main Results:
- Midline use was associated with significantly fewer CRBSIs compared to PICCs (OR, 0.24; 95% CI, 0.15-0.38).
- No significant difference in localized thrombosis or pulmonary embolism risk was found between the groups.
- Higher rates of superficial venous thrombosis were observed with midlines (OR, 2.30; 95% CI, 1.48-3.57).
Conclusions:
- Midline catheters may offer a lower risk of CRBSI compared to PICCs.
- Midline use is associated with an increased risk of superficial vein thrombosis.
- Findings support further research to guide optimal selection between PICCs and midlines.
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