Midline Catheter-Associated Thrombosis (MCAT): Does Tip Location in the Axillary Vein Increase Risk?

Area of Science:

• Vascular Access
• Medical Devices
• Thrombosis Research

Background:

• Midline catheters are used for short- and intermediate-term venous access.
• Guidelines suggest placing the tip in an upper arm vein, avoiding the axillary vein.
• The impact of axillary vein tip placement on MCAT risk is not well-established.

Purpose of the Study:

• To evaluate if axillary vein tip location increases the risk of midline catheter-associated thrombosis (MCAT).

Main Methods:

• Retrospective cohort study of hospitalized patients with midline catheters.
• Analysis included patients with chest x-rays and venous duplex examinations.
• Compared MCAT risk between catheters with tips in arm veins versus the axillary vein.

Main Results:

• 41.5% of catheters with arm vein tips developed thrombus (17/41).
• 38.9% of catheters with axillary vein tips developed thrombus (7/18).
• Axillary vein tip location was not significantly associated with increased MCAT risk in unadjusted or adjusted analyses (OR=0.62, P=0.45).

Conclusions:

• Emerging evidence suggests no increased MCAT risk with axillary vein tip placement.
• The practice of avoiding the axillary vein for midline catheter tips should be reconsidered.