The Midline IV Catheter: An Alternative for Short-Term Infusions
Edward Korycka, MSN, RN
When it comes to delivering short-term infusions, healthcare professionals are often faced with the choice between a Peripheral Intravenous (PIV) catheter and a Midline Vascular Access Catheter. While PIV catheters have long been the standard choice for short-term infusions, recent advances in clinical literature and best practices have shed light on the advantages of using a midline catheter in certain situations. In this blog, we will explore the reasons why choosing a midline vascular access catheter can be a superior option for short-term infusions, supported by published clinical literature and best practices.
Understanding the Basics
Before delving into the advantages of midline catheters, it's essential to understand the fundamental differences between PIV catheters and midline vascular access catheters.
Peripheral Intravenous (PIV) Catheters:
Typically inserted into a superficial peripheral vein, often in the hand or forearm.
Suitable for short-term use (less than a week).
Understood to have a limited dwell time due to increased risk of complications.
Often associated with a higher likelihood of phlebitis and infiltration.
Midline Vascular Access Catheters:
Inserted into a larger peripheral vein in the arm (basilic, brachial, cephalic)
Designed for short to moderate-term use (typically 5 to 14 days).
Lower risk of complications and further reduced need for replacement.
May be better suited for short-term use of known irritants.
Advantages of Midline Catheters
There are many potential advantages of midline catheters over PIV catheters. PIVs are known for their failure rates. Helm and colleagues cite a 35% to 50% failure rate (1) – whether from complications, infiltrations, dislodgement, or a myriad of other reasons. Below we’ve outlined just a handful of the advantages of midline catheters.
Reduced Needle Pokes: Inserting a midline catheter requires fewer needle sticks for the patient. PIV catheters often need to be replaced multiple times, increasing the chances of complications and discomfort for the patient. A recent study indicated a 46% failure for PIVs vs a 16% failure for midlines (2). 29% of the patients in this study required additional vascular access devices to complete therapy. In a 2022 Retrospective medical record review of 130,000 emergency department visits and 1100 inpatient beds, the failure rate was reported at 53.4% with PIVs. (3) Compare this to a recently published HydroMID study, which reported a 4% failure rate with the HydroMID consistently hydrophilic midline catheter. (4)
Improved Patient Satisfaction: Fewer needle pokes leads to improved patient satisfaction and reduced patient anxiety which typically improves the overall patient experience. Data has indicated as much as 30% of patients aged 20-40 have a needle fear which leads to increased anxiety and a negative experience. (5)
Extended Dwell Time: Midline catheters are designed for short to moderate-term use, allowing for extended dwell times of up to 30 days or until it’s determined that they should be removed. In contrast, PIV catheters typically require replacement every few days, increasing the workload on healthcare providers and the cost to hospitals. One study demonstrated a 3.4-day dwell time for peripheral IV catheters (3) while the new hydrophilic midline catheter – HydroMID has demonstrated an average 15.8-day dwell time in a retrospective data review. (6)
Decreased Risk of Complications: Published clinical literature supports the belief that midline catheters have a lower risk of complications such as phlebitis compared to PIV catheters.(4,7) This is especially important when administering medications that can irritate peripheral veins.
Greater Medication Compatibility: Some medications, such as chemotherapy drugs and certain antibiotics, can be highly irritating to peripheral veins. Midline catheters provide a more stable and suitable route for administering these medications, reducing the risk of complications (though irritating medications with longer-term use should defer to guidelines regarding central line access recommendations) .
Best Practices and Guidelines
Leading professional societies and healthcare organizations have recognized the advantages of midline catheters and incorporated them into their best practices and guidelines:
Infusion Nurses Society (INS): The INS recommends midline catheters as an appropriate vascular access device for patients requiring short to moderate-term intravenous therapy (5-14 days). Their guidelines highlight the importance of choosing the right device based on the patient's needs and the therapy being administered. (8)
Centers for Disease Control and Prevention (CDC): The CDC recommends the “Use a midline catheter or peripherally inserted central catheter (PICC), instead of a short peripheral catheter, when the duration of IV therapy will likely exceed six days.” (9)
Wrapping It Up
While PIV catheters have long been the default choice for short-term infusions, the evolving landscape of clinical literature and best practices suggests that midline vascular access catheters offer several advantages. These include improved patient comfort with reduced needle sticks, extended dwell time, and greater compatibility with certain medications. Healthcare professionals should consider the specific needs of their patients and the nature of the therapy being administered when choosing between a PIV catheter and a midline catheter. Ultimately, making informed decisions based on the available evidence and guidelines can lead to better patient outcomes and satisfaction.
References:
1. Helm, Robert E. “Accepted but Unacceptable: Peripheral IV Catheter Failure: 2019 Follow-up.” Journal of infusion nursing : the official publication of the Infusion Nurses Society vol. 42,3 (2019): 149-150. doi:10.1097/NAN.0000000000000324
2. Kleidon TM, Gibson V, Cattanach P, et al. Midline Compared With Peripheral Intravenous Catheters for Therapy of 4 Days or Longer in Pediatric Patients: A Randomized Clinical Trial. JAMA Pediatr. Published online September 11, 2023. doi:10.1001/jamapediatrics.2023.3526
3. Kache S, Patel S, Chen N-W, Qu L, Bahl A. Doomed peripheral intravenous catheters: Bad Outcomes are similar for emergency department and inpatient placed catheters: A retrospective medical record review. The Journal of Vascular Access. 2022;23(1):50-56. doi:10.1177/1129729820974259
4. Bunch J. A retrospective assessment of peripheral midline failures focusing on catheter composition. J InfusNurs. Sept/Oct 2022; 45(5):270-27
5. Alsbrooks K, Hoerauf K. Prevalence, causes, impacts, and management of needle phobia: An international survey of a general adult population. PLoS One. 2022 Nov 21;17(11):e0276814. doi: 10.1371/journal.pone.0276814. PMID: 36409734; PMCID: PMC9678288. 6. https://www.accessvascularinc.com/news/new-access-vascular-retrospective-data-review-demonstrates-midline-catheters-composed-of-advanced-biomaterials-may-improve-dwell-times
6. https://www.accessvascularinc.com/news/new-access-vascular-retrospective-data-review-demonstrates-midline-catheters-composed-of-advanced-biomaterials-may-improve-dwell-times
7. Lee S. e al. (2019) Int J Environ Res Public Health;16(18):3412.
8. Gorski, L. A., Hadaway, L., Hagle, M. E., Broadhurst, D., Clare, S., Kleidon, T., ... & Alexander, M. (2021). Infusion therapy standards of practice. Journal of infusion nursing, 44(1S), S1-S224
9. “Summary of Recommendations” https://www.cdc.gov/infectioncontrol/guidelines/bsi/recommendations.html; Center for Disease Control; Accessed Sept 2023.
