Written by Mary Marschner
Spoon Feed
Midlines for longer courses of antibiotics, other than vancomycin, were associated with fewer complications than PICC lines in the 14 days after insertion.
Perhaps you should picc a MIDLINE
Peripherally inserted central catheters (PICC) and midline catheters (MC) are both safe, usable, and have a relatively low risk of complications including line infections, thrombi, and device failures. Midlines are a good option for IV access less than 14 days, while PICC are indicated for longer access, irritants (like vancomycin), and frequent blood draws. The decision around which line to place is often dictated by what medication will be administered, for how long, and how often labs will be drawn.
This retrospective cohort study compared MC to PICC for outpatient parenteral antimicrobial therapy (OPAT). MCs were associated with lower rates of deep vein thrombosis (1.9% vs. 5.8%; odds ratio, aOR 0.42, 95%CI 0.31–0.56) and central line-associated bloodstream infections (0.5% vs. 3.2%; aOR 0.38, 95%CI 0.22–0.65) compared to PICCs, but were associated with higher rates of device failure (aHR 1.46; 95%CI, 1.04-2.06). When central access is not required, these findings suggest MCs as a safer alternative to OPAT. Despite getting data from 69 hospitals over 6.5 years, the study included only 2824 PICC/midlines, which seems small. Additionally, when midlines in the study exceeded 14 days of placement, there were no differences in outcomes when compared to PICC.
How does this change my practice?
This study is a good reminder to pause and consider how long antibiotics and blood draws will be needed when we are trying to decide PICC line v.s. midline. In general, if a midline will suffice, ask for a midline rather than a PICC; however, often the line and antibiotics may need to continue longer.
Source
Midline vs Peripherally Inserted Central Catheter for Outpatient Parenteral Antimicrobial Therapy. JAMA Intern Med. 2025 Jan 1;185(1):83-91. doi: 10.1001/jamainternmed.2024.5984. PMID: 39527077
