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Randomized Controlled Trial
. 2025 Mar 3;8(3):e251258.
doi: 10.1001/jamanetworkopen.2025.1258.

Midline Venous Catheter vs Peripherally Inserted Central Catheter for Intravenous Therapy: A Randomized Clinical Trial

Ahmed Bentridi  1   2 , Marie-France Giroux  1 , Gilles Soulez  1 , Louis Bouchard  1 , Pierre Perreault  1 , Audrey Chouinard  3 , Marc Dorais  4 , Ricardo Do Amaral  1 , Pascaline Bernier  5 , Eric Therasse  1
Affiliations
Randomized Controlled Trial

Midline Venous Catheter vs Peripherally Inserted Central Catheter for Intravenous Therapy: A Randomized Clinical Trial

Ahmed Bentridi et al. JAMA Netw Open. .

Abstract

Importance: Peripherally inserted central catheters (PICCs) are frequently used for peripheral intravenous therapy (IVT) that could be administered through a peripheral midline venous catheter (MVC).

Objective: To assess the noninferiority of MVCs compared with PICCs as a reliable vascular access for peripheral IVT and blood draws for IVT that does not require a central VC.

Design, setting, and participants: This randomized clinical trial was conducted in a single tertiary care center from September 2018 to March 2022. Participants were all consecutive adult patients who were referred for PICC and eligible for MVC. Patients likely to require a central VC (those in the critical care unit, those with kidney failure, or those requiring a multilumen VC) were excluded. Analyses were based on the evaluable population.

Interventions: Participants were randomized 1:1 to either MVC or PICC. For the MVC group, a 20-cm-long, 4F (French), single-lumen MVC without a valve was used without fluoroscopic assistance. For the PICC group, a 4F, single-lumen PICC without a valve was positioned under fluoroscopy at the cavoatrial junction.

Main outcomes and measures: The primary outcome was the percentage of patients without VC-related adverse events or dysfunctions requiring medical intervention during follow-up. A noninferiority test was performed to compare the proportion of adverse events or dysfunctions between the MVC and PICC groups. A noninferiority margin was set at 10% and a 5% 1-sided significance level.

Results: Of the 6821 patients referred to the tertiary care center for PICC insertion, 294 (180 males [61.2%]; median [IQR] age, 56.3 [38.2-66.7] years) were randomized to receive MVCs (n = 146) or PICCs (n = 148); 135 and 137 participants, respectively, were included in data analysis after exclusion of those who did not complete follow-up. Ninety of 135 patients (66.7%) in the MVC group and 128 of 137 (93.4%) in the PICC group were without VC-related adverse event or dysfunction. The noninferiority of MVC could not be demonstrated (P > .99 for noninferiority).

Conclusions and relevance: In this randomized clinical trial, MVCs were associated with a significantly higher percentage of patients with VC-related adverse events or dysfunctions and could not be demonstrated as a noninferior alternative to PICCs.

Trial registration: ClinicalTrials.gov Identifier: NCT03502980.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Soulez reported receiving grants from Siemens and personal fees from Starpax, Cook Medical, and ViTAA Medical outside the submitted work. Dr Do Amaral reported receiving personal fees from Boston Scientific consulting outside the submitted work. Dr Therasse reported receiving grants from the Department of Radiology of Centre Hospitalier de l’Université de Montréal (CHUM). No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Flowchart of Study Population
Follow-up was available for 272 (92.5%) of 294 randomized patients. MVC indicates midline venous catheter; PICC, peripherally inserted central catheter; and VC, venous catheter.
Figure 2.
Figure 2.. Kaplan-Meyer Analysis of Freedom From Venous Catheter (VC)–Related Adverse Event or Dysfunction
At 50 days after VC insertion, 53.7% of patients in the midline venous catheter (MVC) group and 89.4% in the peripherally inserted central catheter (PICC) group were free from VC-related adverse event or dysfunction (P < .001).
See this image and copyright information in PMC

Comment in

  • doi: 10.1001/jamanetworkopen.2025.1268

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