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Midline vs Peripherally Inserted Central Catheter for Outpatient Parenteral Antimicrobial Therapy

David Paje1,2,3, Emily Walzl1,2, Megan Heath1,2

  • 1Division of Hospital Medicine, Department of Internal Medicine, Michigan Medicine, Ann Arbor.

JAMA Internal Medicine
|November 11, 2024
PubMed
Abstract

Insights

Midline catheters are safe alternatives to peripherally inserted central catheters (PICCs) for outpatient parenteral antimicrobial therapy (OPAT), especially for shorter durations. This study found lower major complication rates with midline catheters for OPAT.

Area of Science:

  • Vascular Access Devices
  • Infectious Diseases
  • Patient Safety

Background:

  • Limited data exists on the comparative safety of midline catheters versus peripherally inserted central catheters (PICCs) for outpatient parenteral antimicrobial therapy (OPAT).
  • Establishing the safety profile of these devices is crucial for optimizing patient care in ambulatory settings.

Purpose of the Study:

  • To compare the incidence of major and minor device-related complications between midline catheters and PICCs in patients receiving OPAT.
  • To evaluate the risk of device failure associated with each catheter type.

Main Methods:

  • A retrospective cohort study analyzed data from 2824 patients across 69 Michigan hospitals (January 2017-November 2023) receiving OPAT via midline catheter or PICC (excluding vancomycin therapy).
  • Cox proportional hazards regression models were used to compare outcomes, adjusting for patient and device confounders and dwell time.
  • Primary outcomes included major complications (catheter-related bloodstream infection, catheter-related venous thromboembolism); secondary outcomes included minor complications and device failure.

Main Results:

  • Midline catheters (70.8%) were more frequently used than PICCs (29.2%).
  • A lower risk of major complications was observed with midline catheters compared to PICCs (aHR, 0.46; 95% CI, 0.23-0.91).
  • For infusions of 14 days or fewer, midline catheters showed significantly lower major complication rates (aHR, 0.29; 95% CI, 0.12-0.68), with similar device failure rates.

Conclusions:

  • Midline catheters demonstrate comparable safety to PICCs for OPAT, with a potentially lower risk of major complications, particularly for shorter treatment durations (≤14 days).
  • These findings suggest midline catheters are a viable and safe alternative for OPAT when appropriate for the prescribed therapy duration.
  • Further research could explore long-term outcomes and specific patient populations.

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