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Midline Compared With Peripheral Intravenous Catheters for Therapy of 4 Days or Longer in Pediatric Patients: A
Tricia M Kleidon1,2,3,4, Victoria Gibson1,2,3, Paula Cattanach1,3
1Department of Anaesthesia and Pain, Children's Health Queensland Hospital and Health Service, Queensland Children's Hospital, Brisbane, Queensland, Australia.
Importance:
Peripheral intravenous catheters (PIVCs) frequently fail during treatment causing therapy interruption, pain, recatheterization, and additional health care costs. Midline catheters (MCs) may improve functional dwell time and reduce failure compared with traditional PIVCs.
Objective:
To compare device failure of MCs with PIVCs.
Design, Setting, And Participants:
This was a pragmatic, randomized clinical superiority trial with an embedded internal pilot study conducted from July 2020 to May 2022. The study took place in a quaternary pediatric hospital in Brisbane, Queensland, Australia. Inclusion criteria were patients aged 1 to 18 years requiring peripherally compatible intravenous therapy for 4 days or longer.
Interventions:
Patients were randomly assigned 1:1 to receive a PIVC or MC, stratified by age (≤5 years, >5 years). One catheter was studied per patient.
Main Outcomes And Measures:
The primary outcome was all-cause device failure, defined as premature cessation of device function. Secondary outcomes included number of insertion attempts, insertion failure, pain (on insertion), procedural time, patient/parent satisfaction (with insertion), device dwell time, device complications during dwell time, additional vascular access devices required to complete treatment, clinician satisfaction (at removal), and health care costs.
Results:
Of the 128 patients randomly assigned to study groups, 127 patients (median [IQR] age, 7 [2-13] years; 71 male [56%]) had a device inserted, with 65 (51.2%) in the PIVC group and 62 (48.8%) in the MC group. All patients were included in the intention-to-treat analysis. Device failure was lower in patients in the MC group (10 [16.1%]) compared with those in the PIVC group (30 [46.2%]; odds ratio [OR], 0.22; 95% CI, 0.10-0.52; P <.001). MCs were associated with fewer insertion attempts (mean difference [MD], -0.3; 95% CI, -0.5 to 0; P = .04), increased dwell time (MD, 66.9 hours; 95% CI, 36.2-97.5 hours; P <.001), and fewer patients required additional vascular access devices to complete treatment in the MC group (4 [6.5%]) and PIVC group (19 [29.2%]; OR, 0.17; 95% CI, 0.05-0.52; P = .002). Compared with PIVCs, use of MCs was associated with greater patient (9.0 vs 7.1 of 10; P = .002) and parent (9.1 vs 8.2 of 10; P = .02) satisfaction and lower health care costs (AUS -$151.67 [US -$101.13] per person; 95% credible interval, AUS -$171.45 to -$131.90 [US -$114.20 to -$87.95]).
Conclusions And Relevance:
Findings suggest that MC insertion for patients requiring peripherally compatible intravenous therapy for 4 days or longer should be prioritized to reduce the resource intensive, expensive, and burdensome sequelae of device failure.
Trial Registration:
Australia New Zealand Clinical Trials Registry, ACTRN12620000724976.
Insights
Midline catheters (MCs) significantly reduce peripheral intravenous catheter (PIVC) failure in pediatric patients needing long-term IV therapy. This leads to fewer complications, increased patient satisfaction, and lower healthcare costs.
Area of Science:
- Vascular Access Devices
- Pediatric Critical Care
- Clinical Trials
Background:
- Peripheral intravenous catheters (PIVCs) often fail, causing treatment interruptions, pain, and increased healthcare costs.
- Midline catheters (MCs) offer a potential alternative to improve dwell time and reduce failure rates compared to PIVCs.
Purpose of the Study:
- To compare the device failure rates between midline catheters (MCs) and peripheral intravenous catheters (PIVCs) in pediatric patients.
- To evaluate secondary outcomes including insertion success, pain, dwell time, complications, and patient/parent satisfaction.
Main Methods:
- A pragmatic, randomized clinical superiority trial involving 128 pediatric patients (aged 1-18 years) requiring intravenous therapy for at least 4 days.
- Patients were randomized 1:1 to receive either a PIVC or an MC, stratified by age.
- The primary outcome was all-cause device failure; secondary outcomes included insertion attempts, pain, dwell time, complications, satisfaction, and costs.
Main Results:
- Midline catheters (MCs) demonstrated significantly lower device failure rates (16.1%) compared to PIVCs (46.2%).
- MCs were associated with fewer insertion attempts, longer dwell times, and reduced need for additional vascular access devices.
- Patients and parents reported higher satisfaction with MCs, and associated healthcare costs were lower.
Conclusions:
- Midline catheter insertion should be prioritized for pediatric patients requiring peripherally compatible intravenous therapy for four days or longer.
- Utilizing MCs can mitigate the resource-intensive, costly, and burdensome consequences of device failure.
- This approach enhances patient care by reducing complications and improving satisfaction.
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