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

A recent large-scale retrospective study published in the Journal of American Medical Association found the comparative safety of midline catheters versus peripherally inserted central catheters (PICCs) for outpatient parenteral antimicrobial therapy (OPAT), a treatment often used following hospital discharge. The research spanned from January 2017 to November 2023 was conducted across 69 Michigan hospitals and was analyzed from April to June 2024.

The study included a total of 2,824 patients, of whom 1,487 (53.5%) were male, with a median age of 66.8 years. In total, 1,999 midline catheters (70.8%) and 825 PICCs (29.2%) were inserted for OPAT. The cases involving vancomycin therapy were excluded to ensure a focus on peripherally compatible treatments.

The key outcomes measured were major device complications, including catheter-related bloodstream infections and venous thromboembolism. Secondary outcomes assessed were minor complications such as catheter dislodgement, occlusion, tip migration, infiltration, superficial thrombophlebitis, and exit site issues, along with overall device failure indicated by the removal due to these complications.

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