Central catheters safer than PICCs for short-term venous access: JAMA
USA: Midline catheters versus peripherally inserted central catheters (PICCs) for short-term indications are associated with a lower risk of occlusion and bloodstream infection, a recent study has revealed. However, it is not clear whether the risk of catheter-associated deep vein thrombosis (DVT) is similar or greater with midlines compared with PICCs for short-term use. The study appears in JAMA Internal Medicine.
In simpler words, judicious use of midlines over PICCs may improve patient safety however there is a need for randomized clinical trials to compare these devices.
Midlines and PICCs are used frequently for short-term venous access; whether one is safer than the other in this setting has not been adequately reported. To shed light on the same, Lakshmi Swaminathan, St Josephs Mercy Health System, Ann Arbor, Michigan, and colleagues aimed to compare outcomes between patients who had a PICC vs midline placed for the indication of difficult vascular access or antibiotic therapy for 30 or fewer days.
The study analyzed data from a multihospital registry including patients who had a PICC or midline placement for the indications of difficult venous access or intravenous antibiotic therapy prescribed for 30 or fewer days. Included patients were admitted to a participating site from December 2017 through January 2020.
The main outcomes were major complications, including a composite of symptomatic catheter-associated deep vein thrombosis, catheter-related bloodstream infection, and catheter occlusion.
The researchers included data on 10 863 patients, 5758 with PICCs, and 5105 with midlines.
Key findings include:
- After adjusting for patient characteristics, comorbidities, catheter lumens, and dwell time in logit models, patients who received PICCs had a greater risk of developing a major complication compared with those who received midlines (odds ratio, 1.99).
- Reduction in complications stemmed from lower rates of occlusion (2.1% vs 7.0%) and bloodstream infection (0.4% vs 1.6%) in midlines vs PICCs; no significant difference in the risk of DVT between PICCs and midlines was observed.
- In time-to-event models, similar outcomes for bloodstream infection and catheter occlusion were noted; however, the risk of DVT events was lower in patients who received PICCs vs midlines (hazard ratio, 0.53).
- Results were robust to sensitivity analyses.
"In this cohort study among patients with the placement of midline catheters vs PICCs for short-term indications, midlines were associated with a lower risk of bloodstream infection and occlusion compared with PICCs," concluded the authors. "Whether DVT risk is similar or greater with midlines compared with PICCs for short-term use is unclear. Therefore, there is a need for randomized clinical trials comparing these devices for this indication are needed."
Reference:
Swaminathan L, Flanders S, Horowitz J, Zhang Q, O'Malley M, Chopra V. Safety and Outcomes of Midline Catheters vs Peripherally Inserted Central Catheters for Patients With Short-term Indications: A Multicenter Study. JAMA Intern Med. Published online November 29, 2021. doi:10.1001/jamainternmed.2021.6844
