Infiltration and Extravasation Risk with Midline Catheters: A Narrative Literature Review.

Area of Science:

• Vascular Access Device Management
• Infusion Therapy
• Patient Safety

Background:

• Midline catheters are gaining popularity, often to reduce central venous catheter use and associated infections.
• There's an increase in non-oncology vesicant medications, with midline catheters frequently used for their infusion.
• The Infusion Nurses Society (INS) Vesicant Task Force flagged midline catheter use as a potential extravasation risk, necessitating a literature review.

Purpose of the Study:

• To review the literature on midline catheter use for vesicant and irritant medication infusions.
• To examine variations in catheter terminology, tip locations, and reported infiltration/extravasation events.
• To assess the evidence base for using midline catheters with vesicant medications and inform clinical decision-making.

Main Methods:

• Comprehensive literature review focusing on midline catheters and vesicant/irritant infusions.
• Analysis of published studies and case reports detailing infiltration and extravasation events.
• Examination of clinical issues related to vascular access device selection and patient safety.

Main Results:

• Significant variations exist in midline catheter terminology and documented tip locations.
• Published studies show a frequency of infiltration and extravasation events associated with midline catheters.
• Despite extensive clinical practice and numerous studies, evidence remains insufficient to definitively assess risks of vesicant infusion via midline catheters.

Conclusions:

• Evidence is insufficient to support the infusion of vesicant and irritant medications through midline catheters.
• Lack of consensus on optimal tip location and inadequate clinical outcome data pose risks.
• Continuous infusion of vesicants, parenteral nutrition, and solutions with extreme pH or osmolarity should be avoided through midline catheters to ensure patient safety.