Our latest paper out new and available free at BMJ Quality Safety here explores use and outcomes of midline catheters in 12 Michigan hospitals. This study is quite possibly the largest prospective cohort study of patients that received midlines as part of clinical care. We followed 1161 devices for 30-days (with phone calls to patients at the end of this time) to understand experiences with these devices.
Our findings are interesting in that they show midlines are very different from PICCs in several ways:
1\ Dwell times are shorter: Almost 50% of devices came out within 5-days of going in
2\ The most common indication for use is Difficult Venous Access (which, incidentally) was among the top indications for PICC use when we began our work with MAGIC 5 years ago!
3\ Major complications including DVT and bloodstream infection are low.
4\ The most common complications were dislodgment, leaking and infiltration.
5\ Midline use varied widely across hospitals. How sick your patients are or how big or complex your hospital is didn't seem to predict your use of this devices. It seems that there are early adopters of midlines that use them a lot vs. others that are still hesitant.
In almost all cases though, they were placed by vascular access teams.
For me, the big takeaway from this work are that its a mistake to think of midlines as a homogenous group of devices. Unlike PICCs that all behave very similarly, how you insert a midline, the materials its made of, what you infuse through it and whether you care and maintain it in specific ways have a lot to do with how the devices last. They're certainly not as forgiving as their longer counterparts!
Case in point: at one of our hospitals, midlines stay in place without problems (they are literally drawing blood from the catheters) at 30-days without issues. At another, they are lucky if they get five days of use.
Understanding what drives these differences is going to be important work that needs to be done. But judging from the outcomes, they clearly have a role in our patients. How to use them safely and ensure that benefit >> risk is going to be key!
Look for more work on midlines coming soon from our HMS collaborative!
Blogs written and edited by Vineet Chopra unless otherwise stated in the header. Guest blogs are identified accordingly.