Comparison of modified midlines versus PICCs in a medical ICU setting: A retrospective study

Intensive care units (ICUs) frequently host patients who often need to be infused with all kinds of drugs. Currently, modified midlines and peripherally inserted central catheters (PICCs) are used frequently. The present retrospective research aims to assess the use, efficacy, and complications due to modified midlines and PICCs in the treatment of patients in a medical ICU. One hundred forty-two patients hospitalized were inserted with a modified midline or PICC. The choice of catheters for different underlying diseases, actual clinical application, the number of days of dwell time, and complications were compared. Risk factors for complications and puncture-site bleeding were investigated. Compared to PICCs, modified midlines were used far more frequently in patients suffering from acute respiratory distress syndrome, chronic obstructive pulmonary disease, cardiovascular diseases, and coronavirus-19 infections; however, this is not the case in malignancy patients. Moreover, modified midlines were more frequently used for the infusion of vasoactive drugs rather than chemotherapeutic drugs. As for overall complications associated with catheter placement, it was significantly different between the 2 groups. Stratified analysis revealed that in the modified midline group, the incidence of partial or complete catheter removal and puncture-site infection was less than the incidence among PICC group; however, modified midline group developed puncture-site bleeding more frequently than PICC group. Multivariate analyses indicated that a catheter indwelling duration of ≥12 days was the only risk factor for complications, rather than PICC. Meanwhile, it also showed that the 2 risk factors for puncture-site bleeding were an age of ≥60 years and ICU stay ≥14 days. In the medical ICU, modified midlines offer a safe alternative to PICCs for medium-term access in non-chemotherapy patients, reducing rates of unplanned removal and puncture-site infection while simplifying clinical workflow.