JournalWise: Safety and Efficacy of Midline vs Peripherally Inserted Central Catheters Among Adults Receiving IV Therapy: A Randomized Clinical Trial.

RCT: In adults receiving IV therapy, midline catheters did not differ from peripherally inserted central catheters for catheter-related bloodstream infections.

Thomsen SL, Boa R, Vinter-Jensen L, et al. Safety and Efficacy of Midline vs Peripherally Inserted Central Catheters Among Adults Receiving IV Therapy: A Randomized Clinical Trial. JAMA Netw Open. 2024 Feb 5;7(2):e2355716. doi: 10.1001/jamanetworkopen.2023.55716.

IMPORTANCE: Midline catheters (MCs) are widely used, but safety and efficacy compared with peripherally inserted central catheters (PICCs) has not been adequately evaluated.

OBJECTIVE: To compare the safety and efficacy of MCs with PICCs among adult patients with an anticipated intravenous therapy lasting from 5 to 28 days.

DESIGN, SETTING, AND PARTICIPANTS: This parallel, 2-group, open-label, randomized clinical trial (RCT) was conducted in Denmark from October 2018 to February 2022 at a single academic tertiary care center. Adult inpatients and outpatients were consecutively randomized.

INTERVENTION: Patients were randomized in a 1:1 ratio to either the MC group or the PICC control group.

MAIN OUTCOMES AND MEASURES: The primary outcome was catheter-related bloodstream infection (CRBSI), analyzed using the Fisher exact test. Secondary outcomes were symptomatic catheter-related thrombosis and catheter failure, including mechanical cause, phlebitis, infiltration, pain in relation to drug or fluid administration, and leaking from the puncture site. Incidence rate ratios (IRRs) were calculated to assess between-group failure rates over device dwell time using Poisson regression. An intention-to-treat analysis was performed.

RESULTS: A total of 304 patients (mean [SD] age, 64.6 [13.5] years; 130 [42.8%] female) were included in the analysis, and 152 patients were allocated to each catheter group. The incidence of CRBSI was low, with 0 in the MC group and 1 in the PICC control group (P > .99). The MC group had a higher catheter-related complication rate (20 [13.2%] vs 11 [7.2%]), and an IRR of 2.37 (95% CI, 1.12-5.02; P = .02) for complications compared with the PICC control group. In a post hoc analysis stratified by catheter dwell time, no significant difference in complication rate (IRR, 1.16; 95% CI, 0.50-2.68; P = .73) was found between the 2 groups for catheters used less than 16 days.

CONCLUSIONS AND RELEVANCE: In this RCT with patients who received medium- to long-term intravenous therapy, the incidence of CRBSI was low, with no difference between MCs and PICCs. The use of MCs resulted in a higher incidence of catheter-related complications compared with use of PICCs. This finding should be balanced in the decision of type of catheter used at the individual patient level.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04140916.

Ratings

Specialty Area	Relevance to Practice	Is this News?	Score
Hospital Doctor/Hospitalists
Internal Medicine

Comments from MORE raters

Hospital Doctor/Hospitalists

Having this information about increased risk of midline catheter-related complications will help physicians make better choices when choosing between MLC and PICCs. This is more relevant now given their increasing availability.

Comments from JournalWise subscribers

Dr. Seth Yandell on 2024-02-29

Of the complications that providers are primarily concerned with (DVT, catheter-associated infection, and phlebitis), there were 3 cases in the PICC group (still a very low number) and 0 cases in the midline group. For me, this article affirms that midlines are a good option for at least moderate-length antibiotic infusion that even with indications like endocarditis newer data suggests that's probably all we need (and the sample size seems too small to say definitively that there is no difference in those important outcomes mentioned above as the relative risk is low even with a PICC).

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