Midline catheters safer for shorter infusion durations compared to peripherally inserted central catheters: JAMA

The findings of the study showed that major device complications occurred in only 1.6% of patients overall. Also, midline catheters had a significantly lower rate of major complications (0.8%) when compared to PICCs (3.4%). The adjusted hazard ratio (aHR) for major complications with midline catheters was 0.46 (95% CI, 0.23-0.91) by highlighting a marked reduction in risk.

Further analysis based on the duration of device use revealed that midline catheters were especially beneficial for short-term use (up to 14 days). In this group, only 0.9% of midline catheter users experienced major complications when compared to 5.3% for PICC users (aHR, 0.29; 95% CI, 0.12-0.68). Also, for device use longer than 14 days, the difference in major complication rates was not significant (0.6% for midline catheters vs. 2.3% for PICCs; aHR, 0.42; 95% CI, 0.13-1.40).

Minor complications and device failure rates were found to be comparable between the two groups, with minor issues affecting 10.3% of midline catheter users versus 13.8% of PICC users (aHR, 1.07; 95% CI, 0.83-1.38). The device failure rates were also similar, at 9.6% for midline catheters and 12.1% for PICCs (aHR, 1.26; 95% CI, 0.96-1.65). Overall, the outcomes underline that midline catheters can be a safer alternative to PICCs for OPAT, particularly when therapy is expected to last for 14 or fewer days.

Source:

Paje, D., Walzl, E., Heath, M., McLaughlin, E., Horowitz, J. K., Tatarcuk, C., Swaminathan, L., Kaatz, S., Malani, A. N., Vaughn, V. M., Bernstein, S. J., Flanders, S. A., & Chopra, V. (2024). Midline vs Peripherally Inserted Central Catheter for Outpatient Parenteral Antimicrobial Therapy. In JAMA Internal Medicine. American Medical Association (AMA). https://doi.org/10.1001/jamainternmed.2024.5984