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Midlines – A Central Line Alternative?

February 10, 2020

Written by Clay Smith

Spoon Feed
Midline catheters had a low complication rate and high rate of successful placement in critically ill ED patients, presenting a safe alternative to a central line.

Why does this matter?
Placing a central venous catheter (CVC) has pros and cons. They are ideal for vasoactive infusions or sclerosing medications. But there are serious potential complications as well. Standard IV catheters placed in deeper veins under ultrasound guidance don’t tend to last long, maybe a day. A midline catheter is a peripheral, ultrasound guided 10-25 cm catheter placed with Seldinger technique. Midlines have already been shown to have lower infection risk than CVCs. How do midline catheters perform in other ways?

Central line alternative?
This was a prospective series of 403 patients who had midline catheters placed in the ED over almost two years. Midline placement success was 99%, with 64% first time success. Of these, 96% used ultrasound; others were over a wire. They remained in for a median duration of 5 days. Fourteen patients (3.5%) had 15 insertion complications, mostly failure to aspirate, but there was 1 arterial puncture, 4 hematomas (hematomata?), 1 DVT, 1 infiltration, and 3 that just failed. In addition, 49 patients (12%) had 60 complications related to ongoing use, such as leaking, dislodgment, or redness. There were no known bloodstream infections. Data were collected using review of a custom built electronic procedure note, which leaves something to be desired as far as rigor and standardization of data collection. Overall, midlines were highly successful, with a fairly low complication rate.

The Utility of Midline Intravenous Catheters in Critically Ill Emergency Department Patients. Ann Emerg Med. 2019 Dec 24. pii: S0196-0644(19)31236-3. doi: 10.1016/j.annemergmed.2019.09.018. [Epub ahead of print]

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