Comparative Safety of Midline Catheters and PICCs in Long-term Intravenous Therapy

The primary outcome under scrutiny was the occurrence of catheter-related bloodstream infection (CRBSI), a critical factor in evaluating the safety of these catheter types. Secondary outcomes encompassed symptomatic catheter-related thrombosis and catheter failure, which included issues such as mechanical causes, phlebitis, infiltration, pain associated with drug or fluid administration, and leakage from the puncture site.

Findings:

• Strikingly, the incidence of CRBSI was remarkably low, with no reported cases in the MC group and only one case in the PICC control group (P > .99).
• This finding suggests that both MCs and PICCs exhibit comparable efficacy in preventing CRBSI in the specified patient population.
• However, delving into secondary outcomes, the study revealed a noteworthy distinction.
• The MC group exhibited a higher overall catheter-related complication rate (13.2%) compared to the PICC control group (7.2%).
• Further analysis, using the incidence rate ratio (IRR), demonstrated a statistically significant IRR of 2.37 (95% CI, 1.12-5.02; P = .02) in favor of the PICC group.
• In a post hoc analysis stratified by catheter dwell time, the researchers explored the impact of catheter use for less than 16 days.
• Interestingly, this subset analysis did not reveal a significant difference in complication rates between the two groups (IRR, 1.16; 95% CI, 0.50-2.68; P = .73).  

The study's conclusion emphasizes the low incidence of CRBSI with both catheter types but highlights the higher incidence of catheter-related complications with MCs. Researchers recommend a nuanced approach in the decision-making process, considering individual patient characteristics and the expected duration of intravenous therapy.            

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