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Comparison of Complication Rates of Midline Catheter versus Peripherally Inserted Central Catheter: An Update
Yu Tian1, Ruizhi Wang2, Xuesong Yao1
1Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, Guangdong Province, China.
Background:
In this meta-analysis, we compared the clinical outcomes and complications of using midline catheters (MCs) versus peripherally inserted central catheters (PICCs) among patients undergoing intravenous therapy (IVT). Our goal was to evaluate the relative risk of complications from MCs and PICCs.
Methods:
We performed an extensive review and meta-analysis of randomized controlled trials (RCTs) and observational investigations. Literature screening was carried out using the electronic databases Embase, Ovid, Cochrane Library, PubMed, and Google Scholar from the day of database establishment till February 26, 2025. Eligible studies included those that compared complication rates among patients using either PICCs or MCs for IVT. Our primary end point was major complications, including catheter-related vein thrombosis (CRVT) and catheter-related bloodstream infection (CRBSI). Among the secondary end points were phlebitis, pain, catheter dislodgement, catheter infiltration, and total complications. All data analyses were conducted using Stata (version 14).
Results:
The initial screening produced 8,410 articles. Among them, only 11 studies, including 3 RCTs and 8 observational investigations, met our strict inclusion criteria. Based on our meta-analysis, MCs were associated with a significantly higher incidence of CRVT compared to PICCs (incidence rate ratio [IRR], 1.91; 95% confidence interval [CI], 1.13-3.23; P = 0.016; I2= 13.5%), but with a significantly lower incidence of CRBSI (IRR, 0.58; 95% CI, 0.37-0.91; P = 0.018; I2= 0%). Among secondary outcomes, MCs showed a markedly increased risk of infiltration (IRR, 8.41; 95% CI, 2.53-27.93; P = 0.001; I2= 0%) and total complications (IRR, 2.54; 95% CI, 1.29-5.02; P = 0.007; I2= 78.8%). No statistically significant differences were observed between MCs and PICCs in terms of phlebitis (IRR, 2.11; 95% CI, 0.78-5.68; P = 0.14; I2= 0%), dislodgement (IRR, 2.33; 95% CI, 0.58-9.33; P = 0.23; I2= 63.5%), or pain (IRR, 1.76; 95% CI, 0.49-6.38; P = 0.39; I2= 32.7%) CONCLUSION: Our findings suggest that MCs increased the risk of CRVT and reduced the risk of CRBSI relative to PICCs. These findings can help guide future analyses and direct comparative RCTs to further characterize the efficacy and risks of PICCs versus MCs.
Insights
Midline catheters (MCs) show a higher risk of catheter-related vein thrombosis but a lower risk of catheter-related bloodstream infections compared to peripherally inserted central catheters (PICCs). This meta-analysis highlights differing complication profiles for IVT.
Area of Science:
- Vascular Access Devices
- Infectious Disease Epidemiology
- Clinical Interventions
Background:
- Comparing clinical outcomes and complications of midline catheters (MCs) versus peripherally inserted central catheters (PICCs) for intravenous therapy (IVT).
- Evaluating the relative risk of complications associated with MCs and PICCs in patient populations.
Purpose of the Study:
- To conduct a meta-analysis comparing the incidence of major and secondary complications between MCs and PICCs.
- To assess the relative risk of catheter-related vein thrombosis (CRVT) and catheter-related bloodstream infection (CRBSI) for MCs versus PICCs.
Main Methods:
- Systematic review and meta-analysis of randomized controlled trials (RCTs) and observational studies.
- Literature search across Embase, Ovid, Cochrane Library, PubMed, and Google Scholar up to February 26, 2025.
- Primary endpoints: CRVT and CRBSI; Secondary endpoints: phlebitis, pain, dislodgement, infiltration, and total complications.
Main Results:
- 11 studies (3 RCTs, 8 observational) included. MCs showed significantly higher CRVT risk (IRR, 1.91) but significantly lower CRBSI risk (IRR, 0.58) versus PICCs.
- MCs had a markedly increased risk of infiltration (IRR, 8.41) and total complications (IRR, 2.54).
- No significant differences found for phlebitis, dislodgement, or pain between MCs and PICCs.
Conclusions:
- Midline catheters are associated with an increased risk of CRVT and a reduced risk of CRBSI compared to PICCs.
- Findings suggest different complication profiles, necessitating careful consideration in clinical practice.
- Further comparative RCTs are recommended to fully characterize the efficacy and risks of MCs versus PICCs.
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