Midclavicular catheters in the antepartum population. A continuous quality improvement review

After a catheter-induced subclavian thrombosis, a continuous quality improvement (CQI) study was undertaken to answer the question: Are midclavicular lines appropriate in high-risk obstetric patients? This article reports the findings of a retrospective chart audit that described 32 consecutively placed midclavicular lines in a high-risk obstetric population. Study variables included maternal and catheter characteristics, as well as dwell time and rationales for line discontinuance. Therapy was completed in 68%. There were no episodes of noncompliance, catheter malfunction, or bleeding. Episodes of phlebitis and occlusion were relatively uncommon; positive cultures occurred in six catheter tips but were unaccompanied by any clinical evidence indicative of bacteremia or catheter sepsis. However, given the growing recognition of the risks of subclinical and clinical thrombosis endemic to the midclavicular position, increasing reports of malposition that are logistically unable to address, and the growing number of osmotically active solutions being used that are not suited to anything other than superior vena cava dilution, the authors have stopped placing midclavicular catheters in the high-risk obstetric population.