Midline Catheters for Administering Intravenous Infusion Therapy

Key Message

What Is the Issue?

Used to administer medications, nutrition, blood products, and other fluids, IV infusion therapy is an important part of clinical care across various health care settings.

Multiple types of venous access devices are available for IV therapy, including peripheral and central devices. Selecting the most appropriate venous access device is essential for ensuring patient safety and comfort.

Midline catheters, a type of peripheral venous access device, are increasingly used as an alternative to other peripheral catheters and central venous access devices. However, variations in clinical practice and uncertainty regarding their optimal use create challenges for clinicians and policy-makers in standardizing care.

What Did We Do?

• We prepared this Rapid Review to summarize and critically appraise the available studies on the clinical effectiveness of midline catheters compared to other vascular access devices to support decision-making about the use of midline catheters for administering IV infusion therapy. We also sought to identify evidence-based guidelines regarding the use of midline catheters for administering IV infusion therapy.
• We searched key resources, including journal citation databases, and conducted a focused internet search for relevant evidence published since 2020. Two reviewers screened articles for inclusion based on predefined criteria, critically appraised the included studies, and narratively summarized the findings.

What Did We Find?

• We found 8 systematic reviews (SRs) that evaluated the clinical effectiveness of midline catheters compared to peripherally inserted central catheters (PICCs) (7 SRs) and central venous catheters (1 SR) for administrating IV infusion therapy, as well as 5 evidence-based guidelines that provide recommendations on the appropriate indications for midline catheter use.
• Compared to PICCs, midline catheters may be associated with higher rates of total complications, catheter-related venous thromboembolism, catheter leakage, treatment discontinuation or premature catheter removals, infiltration, and shorter mean catheter dwell times. Midline catheters were also associated with lower rates of catheter-related bloodstream infection. None of the included SRs detected statistically significant differences between midline catheters and PICCs for phlebitis, catheter occlusion, catheter displacement, or mortality.
• Compared to central venous catheters, midline catheters were associated with lower rates of total complications, catheter-related thrombosis, catheter-related infections, and catheter blockage. They also had longer mean catheter dwell times. The SR that examined this comparison did not find significant differences in phlebitis, catheter leakage, or catheter displacement.
• Although some SRs reported statistically significant differences between midline catheters and other venous access devices, these findings were inconsistent across the included studies. Not all SRs detected statistically significant between-group differences for each of these outcomes.
• The quality of the SRs described in this Rapid Review, as well as the quality of primary studies included in the SRs, was limited. Most of the clinical evidence summarized in this review is from low-to-moderate quality nonrandomized studies that may be influenced by selection bias, confounding bias, and performance bias.
• We did not find any studies on the clinical effectiveness of midline catheters versus other peripheral venous access devices for administering IV infusion therapy that met our selection criteria for this review.
• Evidence-based guidelines based mostly on low-quality evidence or expert opinion recommend considering midline catheters as an option in various clinical scenarios, including for children and adults who need longer-term peripheral venous access (e.g., up to 4 weeks). Guidelines also recommend avoiding the use of midline catheters for administering continuous vesicant therapy, parenteral nutrition, or solutions with extremes of pH or osmolarity and for patients with a history of thrombosis, hypercoagulability, decreased venous flow to the extremities, end-stage renal disease requiring vein preservation, or with planned or existing arteriovenous fistula or arteriovenous graft.

What Does This Mean?

• Health care professionals and decision-makers can use this evidence to inform decisions around the appropriate use of midline catheters for administering IV infusion therapy.
• Current evidence-based guidelines support the use of midline catheters in certain clinical scenarios after consideration for the type and anticipated duration of therapy and individual patient needs.
• Further high-quality research from robustly conducted studies with improved reporting is needed to confirm the clinical effectiveness of midline catheters versus other vascular access devices.