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Randomized Controlled Trial
. 2024 Feb 5;7(2):e2355716.
doi: 10.1001/jamanetworkopen.2023.55716.

Safety and Efficacy of Midline vs Peripherally Inserted Central Catheters Among Adults Receiving IV Therapy: A Randomized Clinical Trial

Simon L Thomsen  1 , Rikke Boa  1 , Lars Vinter-Jensen  2   3 , Bodil S Rasmussen  1   3
Affiliations
Randomized Controlled Trial

Safety and Efficacy of Midline vs Peripherally Inserted Central Catheters Among Adults Receiving IV Therapy: A Randomized Clinical Trial

Simon L Thomsen et al. JAMA Netw Open. .

Abstract

Importance: Midline catheters (MCs) are widely used, but safety and efficacy compared with peripherally inserted central catheters (PICCs) has not been adequately evaluated.

Objective: To compare the safety and efficacy of MCs with PICCs among adult patients with an anticipated intravenous therapy lasting from 5 to 28 days.

Design, setting, and participants: This parallel, 2-group, open-label, randomized clinical trial (RCT) was conducted in Denmark from October 2018 to February 2022 at a single academic tertiary care center. Adult inpatients and outpatients were consecutively randomized.

Intervention: Patients were randomized in a 1:1 ratio to either the MC group or the PICC control group.

Main outcomes and measures: The primary outcome was catheter-related bloodstream infection (CRBSI), analyzed using the Fisher exact test. Secondary outcomes were symptomatic catheter-related thrombosis and catheter failure, including mechanical cause, phlebitis, infiltration, pain in relation to drug or fluid administration, and leaking from the puncture site. Incidence rate ratios (IRRs) were calculated to assess between-group failure rates over device dwell time using Poisson regression. An intention-to-treat analysis was performed.

Results: A total of 304 patients (mean [SD] age, 64.6 [13.5] years; 130 [42.8%] female) were included in the analysis, and 152 patients were allocated to each catheter group. The incidence of CRBSI was low, with 0 in the MC group and 1 in the PICC control group (P > .99). The MC group had a higher catheter-related complication rate (20 [13.2%] vs 11 [7.2%]), and an IRR of 2.37 (95% CI, 1.12-5.02; P = .02) for complications compared with the PICC control group. In a post hoc analysis stratified by catheter dwell time, no significant difference in complication rate (IRR, 1.16; 95% CI, 0.50-2.68; P = .73) was found between the 2 groups for catheters used less than 16 days.

Conclusions and relevance: In this RCT with patients who received medium- to long-term intravenous therapy, the incidence of CRBSI was low, with no difference between MCs and PICCs. The use of MCs resulted in a higher incidence of catheter-related complications compared with use of PICCs. This finding should be balanced in the decision of type of catheter used at the individual patient level.

Trial registration: ClinicalTrials.gov Identifier: NCT04140916.

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Conflict of interest statement

Conflict of Interest Disclosures: None reported.

Figures

Figure 1.
Figure 1.. Flow Diagram for the Randomization and Analysis of Patients
MC indicates midline catheter; PICC, peripherally inserted central catheter.
Figure 2.
Figure 2.. Unadjusted Kaplan-Meier Estimates of Cumulative Catheter Removal Rates
MC indicates midline catheter; PICC, peripherally inserted central catheter.
See this image and copyright information in PMC

Comment in

References

    1. Hadaway L. Short peripheral intravenous catheters and infections. J Infus Nurs. 2012;35(4):230-240. doi:10.1097/NAN.0b013e31825af099 - DOI - PubMed
    1. Dychter SS, Gold DA, Carson D, Haller M. Intravenous therapy: a review of complications and economic considerations of peripheral access. J Infus Nurs. 2012;35(2):84-91. doi:10.1097/NAN.0b013e31824237ce - DOI - PubMed
    1. Tagalakis V, Kahn SR, Libman M, Blostein M. The epidemiology of peripheral vein infusion thrombophlebitis: a critical review. Am J Med. 2002;113(2):146-151. doi:10.1016/S0002-9343(02)01163-4 - DOI - PubMed
    1. Rickard CM, Webster J, Wallis MC, et al. . Routine versus clinically indicated replacement of peripheral intravenous catheters: a randomised controlled equivalence trial. Lancet. 2012;380(9847):1066-1074. doi:10.1016/S0140-6736(12)61082-4 - DOI - PubMed
    1. Pittiruti M, Van Boxtel T, Scoppettuolo G, et al. . European recommendations on the proper indication and use of peripheral venous access devices (the ERPIUP consensus): a WoCoVA project. J Vasc Access. 2023;24(1):165-182. doi:10.1177/11297298211023274 - DOI - PubMed

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