Safety and Outcomes of Midline and Peripherally Inserted Central Catheters in a Pediatric Intensive Care Unit

We describe our experience with use of midline catheters in PICU and compare the performance of midline catheters to peripherally inserted central catheters (PICC).

A review of hospital records was done to including all pediatric patients admitted in the pediatric intensive care unit of a tertiary care centre who underwent placement of midline catheters or PICC, over a period of 18 months (July, 2019 to January, 2021). Patient details, indication, type of catheter and number of attempts at insertion, type and number of infusions administered, dwell time and complications were retrieved from the records. Comparison was made between the midline and PICC groups.

The median (IQR) age of children was 7 (3-12) years (75.5% males). 161 midline catheters and 104 PICC were inserted with first attempt success rates of 87.6% and 78.8%, respectively. Median cubital vein was used for majority of the insertions (52.8%). Common complications with midline catheters were pain (n=9, 5.6%), blockage (n=8, 5%) and thrombophlebitis (n=6, 3.7%). Median (interquartile range) dwell time in midline group was 7 (5-10) days. The duration of backflow and dwell time were higher in the PICC group compared to midline group (5.5 vs 3 days; P<0.001 and 9 vs 7 days; P<0.001, respectively).

Retrospective data showed that midline catheters had good utility in PICU, especially in moderately sick children (PRISM score up to 12), and provide a secure intravenous access, which can last for a week.