Midline Catheter
A midline catheter is a peripheral vascular access catheter typically placed in large upper arm veins under ultrasound guidance.
Venous access devises can range from simple peripheral IVs (PIVs), to the midline catheter, to peripherally inserted central lines (PICC), and to central venous catheters (CVC). Each type of vascular access device can serve multiple roles, however each device can provide benefits in specific situations. PIVs are the most common and easiest to insert, but are the most likely to be accidentally dislodged or infiltrate. The central line is more invasive, has additional associated procedural complications, higher rate of line infections, but also allows for high concentration and central administration of medications. The midline catheter falls in the middle of this range.
A midline catheter is generally 8 - 12 cm in length and placed in the upper arm with the tip located just below the axilla. The longer catheter and large vein selection decreases the risk of infiltration and accidental catheter tip dislodgment. This type of line is optimal for patients with difficult to obtain non-ultrasound guided PIVs as well as patients with expected frequent IV medication administration over a 1-2 week hospital course. The long length slows fluid administration, and therefore this access devise is suboptimal for high volume rapid resuscitation. A larger arm vessel provides better drug hemodilution than the smaller vessels used for standard peripheral catheters, reducing phlebitis and infiltration risks.
Vascular Access Device Risks[1]
| Device | PIV | MC | PICC | CVC |
|---|---|---|---|---|
| Catheter associated blood stream infection (per 1000 catheter days) | 0.5 | 0.2 | 2.1–2.3 | 2.4–2.7 |
| Average inpatient dwell time (days) | 2.9–4.1 | 7.69–16.4 | 7.3–16.6 | N/A |
| Cost of insertion (in hospital)† | $9.67 | $94.88 | $94.88 | $124.96 |
| Failed first attempt (%) | 12–26 | 3.2 | 1.2 | 14 |
| Procedure time (minutes) | 2.5–13 | 9.5 | N/A | 2.3 |
| Rate of infiltration (%) | 23.9 | Unknown | N/A | N/A |
PIV = peripheral intravenous catheter; MC = midline catheter; PICC = peripherally inserted central catheter; CVC = central venous catheter;
Procedure variants
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References
- ↑ Adams, Daniel Z.; Little, Andrew; Vinsant, Charles; Khandelwal, Sorabh (2016-09). "The Midline Catheter: A Clinical Review". The Journal of Emergency Medicine. 51 (3): 252–258. doi:10.1016/j.jemermed.2016.05.029. ISSN 0736-4679. Check date values in:
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