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Midline catheter tip position and catheter-related complications in antimicrobial therapy: A multi-center randomized
Linfang Zhao1, Xiaopeng Fan2, Lei Zhao3
1Nursing Department, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China.
Background:
The use of midline catheters (MCs) in intravenous therapy has increased over the last few years; however, scientific evidence is scarce. The recommendations for its specific tip position and safe use in antimicrobial therapy are not well established, which increases the risk of catheter-related complications.
Objective:
This study aimed to provide evidence for selecting MC tip positions for safe use in antimicrobial therapy.
Design:
This prospective, randomized controlled trial compared catheter-related complications with different tip positions. Participants were assigned to three different catheter tip groups, and the relationship between the tip position and catheter-related complications was observed during antimicrobial therapy.
Setting:
Multicenter trial based in intravenous therapy centers at six Chinese hospitals.
Participants:
A fixed-point continuous convenience sampling method was used to enroll 330 participants. Three different study groups with equal numbers of participants (n = 110) were established using a randomization technique.
Methods:
The incidence of catheter-related complications and catheter retention time was compared among the three groups. The catheter measurement data between the three groups were compared using one-way ANOVA or the Kruskal-Wallis tests. Counting data were compared using chi-square tests, Fisher's exact tests, and Kruskal-Wallis tests. Post-hoc tests were conducted to compare the incidence of complications among the three groups. We followed a time-to-event analysis approach and used Kaplan-Meier curves and log-rank tests to analyze the relationship between catheter-related complications and different tip positions.
Results:
The total incidence of catheter-related complications in Experimental Groups 1 and 2 as well as the control group were 10.09%, 17.98%, and 33.73%, respectively. Statistically significant differences existed between the groups (p < 0.0001). In pairwise comparisons of the three groups, significant differences were evident in the incidence of complications between Experimental Group 1 and the control group (RD 19.40%, confidence interval 7.71-31.09). No statistical significance in the incidence of complications between Experimental Group 1 and Experiment Group 2 (RD -4.93%, confidence interval -14.80-4.95) and in the incidence of complications between Experimental Group 2 and the control group (RD 14.47%, confidence interval 1.82-27.12) were noted.
Conclusion:
Catheter-related complications were reduced when the tip of the Midline Catheter was located in the subclavian or axillary vein of the chest wall.
Trial Registration:
NCT04601597(https://clinicaltrials.gov/ct2/show/NCT04601597). Registration date: September 1, 2020.
Insights
Optimal midline catheter (MC) tip placement in the subclavian or axillary vein significantly reduces catheter-related complications during antimicrobial therapy. This evidence supports safer intravenous therapy practices.
Area of Science:
- Vascular Access Devices
- Infectious Diseases
- Clinical Trials
Background:
- Midline catheters (MCs) are increasingly used in intravenous therapy, but evidence on optimal tip positioning and safe antimicrobial therapy use is limited.
- Lack of established guidelines increases the risk of catheter-related complications.
Purpose of the Study:
- To provide evidence-based recommendations for midline catheter tip positions to ensure safe use in antimicrobial therapy.
- To compare catheter-related complications associated with different MC tip locations.
Main Methods:
- A prospective, randomized controlled trial involving 330 participants across six hospitals.
- Participants were randomized into three groups based on catheter tip position.
- Complications and catheter dwell time were compared using statistical analyses, including ANOVA, Kruskal-Wallis, chi-square tests, and Kaplan-Meier curves.
Main Results:
- The incidence of catheter-related complications was significantly lower in Experimental Group 1 (10.09%) compared to the control group (33.73%) (p < 0.0001).
- Experimental Group 1, with tip placement in the subclavian or axillary vein, showed a 19.40% risk reduction in complications versus the control group.
- No significant difference in complications was observed between Experimental Group 1 and Experimental Group 2, or between Experimental Group 2 and the control group.
Conclusions:
- Placing the midline catheter tip in the subclavian or axillary vein is associated with a reduced incidence of catheter-related complications.
- This finding supports optimizing MC tip position for enhanced patient safety during antimicrobial therapy.
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