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. 2023 Jan 18;10(2):ofad024.
doi: 10.1093/ofid/ofad024. eCollection 2023 Feb.

Comparing Complication Rates of Midline Catheter vs Peripherally Inserted Central Catheter. A Systematic Review and Meta-analysis

Meritxell Urtecho  1   2 , Victor D Torres Roldan  1   2 , Tarek Nayfeh  1   2 , Nataly R Espinoza Suarez  3 , Nischal Ranganath  4 , Priya Sampathkumar  4 , Vineet Chopra  5 , Nasia Safdar  6 , Larry J Prokop  7 , John C O'Horo  4   8
Affiliations

Comparing Complication Rates of Midline Catheter vs Peripherally Inserted Central Catheter. A Systematic Review and Meta-analysis

Meritxell Urtecho et al. Open Forum Infect Dis. .

Abstract

Background: Peripherally inserted central catheters (PICCs) and midlines are commonly used devices for reliable vascular access. Infection and thrombosis are the main adverse effects of these catheters. We aimed to evaluate the relative risk of complications from midlines and PICCs.

Methods: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) and observational studies. The primary outcomes were catheter-related bloodstream infection (CRBSI) and thrombosis. Secondary outcomes evaluated included mortality, failure to complete therapy, catheter occlusion, phlebitis, and catheter fracture. The certainty of evidence was assessed using the GRADE approach.

Results: Of 8368 citations identified, 20 studies met the eligibility criteria, including 1 RCT and 19 observational studies. Midline use was associated with fewer patients with CRBSI compared with PICCs (odds ratio [OR], 0.24; 95% CI, 0.15-0.38). This association was not observed when we evaluated risk per catheter. No significant association was found between catheters when evaluating risk of localized thrombosis and pulmonary embolism. A subgroup analysis based on location of thrombosis showed higher rates of superficial venous thrombosis in patients using midlines (OR, 2.30; 95% CI, 1.48-3.57). We did not identify any significant difference between midlines and PICCs for the secondary outcomes.

Conclusions: Our findings suggest that patients who use midlines might experience fewer CRBSIs than those who use PICCs. However, the use of midline catheters was associated with greater risk of superficial vein thrombosis. These findings can help guide future cost-benefit analyses and direct comparative RCTs to further characterize the efficacy and risks of PICCs vs midline catheters.

Keywords: PICC; catheter; infection; midline; thrombosis.

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Figures

Figure 1.
Figure 1.
Selection of trials for inclusion in the review and meta-analysis.
Figure 2.
Figure 2.
Forest plot comparing rates of CRBSI in patients with midlines vs PICCs. Abbreviations: CRBSI, catheter-related bloodstream infection; PICCs, peripherally inserted central catheters.
Figure 3.
Figure 3.
Subgroup analysis based on thrombosis localization.
See this image and copyright information in PMC

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