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Comparative Study
. 2025 Jan 1;185(1):83-91.
doi: 10.1001/jamainternmed.2024.5984.

Midline vs Peripherally Inserted Central Catheter for Outpatient Parenteral Antimicrobial Therapy

David Paje  1   2   3 , Emily Walzl  1   2 , Megan Heath  1   2 , Elizabeth McLaughlin  1   2 , Jennifer K Horowitz  1   2 , Caitlin Tatarcuk  1   2 , Lakshmi Swaminathan  4 , Scott Kaatz  5 , Anurag N Malani  6 , Valerie M Vaughn  1   7 , Steven J Bernstein  2   8   9 , Scott A Flanders  1   2 , Vineet Chopra  2   10
Affiliations
Comparative Study

Midline vs Peripherally Inserted Central Catheter for Outpatient Parenteral Antimicrobial Therapy

David Paje et al. JAMA Intern Med. .

Abstract

Importance: Little is known about the safety of midline catheters vs peripherally inserted central catheters (PICCs) for outpatient parenteral antimicrobial therapy (OPAT).

Objective: To compare outcomes from midline catheters vs PICCs for OPAT.

Design, setting, and participants: This retrospective cohort study included patients who received antimicrobial therapy through a midline catheter or PICC between January 2017 and November 2023 across 69 Michigan hospitals. Because peripherally compatible OPAT was the indication of interest, vancomycin therapy was excluded. Data were analyzed from April to June 2024.

Exposures: Insertion of a midline catheter or PICC for OPAT following hospitalization.

Main outcomes and measures: The primary outcome was major device complications (ie, catheter-related bloodstream infection or catheter-related venous thromboembolism). Secondary outcomes included minor device complications (eg, catheter dislodgement, occlusion, tip migration, infiltration, superficial thrombophlebitis, or exit site concerns) and device failure, defined as catheter removal following device complication. Cox proportional hazards regression models were fit to device type and outcomes, adjusting for patient and device confounders and device dwell.

Results: Of 2824 included patients, 1487 (53.5%) were male, and the median (IQR) age was 66.8 (55.9-77.1) years. Of 2824 devices placed for OPAT, 1999 (70.8%) were midline catheters and 825 (29.2%) were PICCs. The median (IQR) dwell time was 12 (8-17) days for midline catheters and 19 (12-27) days for PICCs (P < .001). A major device complication occurred in 44 patients (1.6%) overall, including 16 (0.8%) with midline catheters and 28 (3.4%) with PICCs (P < .001). OPAT delivered via midline catheters was associated with a lower risk of major complications vs PICCs (adjusted hazard ratio [aHR], 0.46; 95% CI, 0.23-0.91). Risks of minor complications and device failure were similar across device types (minor complications: 206 of 1999 [10.3%] vs 114 of 825 [13.8%]; aHR, 1.07; 95% CI, 0.83-1.38; device failure: 191 of 1999 [9.6%] vs 100 of 825 [12.1%]; aHR, 1.26; 95% CI, 0.96-1.65). For device dwell of 14 or fewer days, midline catheters were associated with a lower risk of major complications (12 of 1324 [0.9%] vs 16 of 304 [5.3%]; aHR, 0.29; 95% CI, 0.12-0.68) and similar risk of failure (151 of 1324 [11.4%] vs 52 of 304 [17.1%]; aHR, 0.79; 95% CI, 0.56-1.12) vs PICCs. For dwell longer than 14 days, no significant difference in rates of major complications (4 of 675 [0.6%] vs 12 of 521 [2.3%]; aHR, 0.42; 95% CI, 0.13-1.40) or device failure (40 of 675 [5.9%] vs 48 of 521 [9.2%]; aHR, 1.02; 95% CI, 0.64-1.61) were observed.

Conclusions and relevance: In this study, midline catheters appeared to be safe alternatives to PICCs for OPAT, particularly if infusions were planned for 14 or fewer days.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Paje reported grants from Blue Cross Blue Shield of Michigan during the conduct of the study. Dr Heath reported grants from Blue Cross and Blue Shield of Michigan and Blue Care Network during the conduct of the study. Ms McLaughlin is a member of the Blue Cross Blue Shield of Michigan Value Partnership Program during the conduct of the study. Dr Kaatz reported received support from Blue Cross Blue Shield of Michigan during the conduct of the study. Dr Bernstein reported grants from Blue Cross Blue Shield of Michigan to the Michigan Hospital Medicine Safety Consortium Collaborative Quality Initiative during the conduct of the study. Dr Chopra reported support from the Blue Cross Blue Shield Network during the conduct of the study. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Flow Diagram for Cohort Selection
ICU indicates intensive care unit; OPAT, outpatient parenteral antimicrobial therapy; PICC, peripherally inserted central catheter.
Figure 2.
Figure 2.. Complications in Patients Receiving Outpatient Parenteral Antimicrobial Therapy by Device Type
PICC indicates peripherally inserted central catheter.
See this image and copyright information in PMC

References

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