Background: Vascular access devices (VADs) play an integral role in the treatment of patients, since they can be utilized for the administration of intravenous medications (including antibiotics and chemotherapy), and often on a long term basis. A peripherally inserted central catheter (PICC) is a type of VAD, which is frequently utilized in different populations. Once inserted, a PICC can be used for up to 6 months. Although there are substantial benefits to using PICCs in patients who require them, it is well known that there are also potential complications associated with their use. The two most common complications are central line-associated bloodstream infections (CLABSIs) and PICC-related venous thrombosis. A midline catheter is another type of VAD, which first came into clinical use in the 1950s. Once a midline catheter has been inserted, it can be used for up to 30 days.
The frequency of complications associated with the use of midline catheters has not been as well studied as it has for PICC lines. The primary goal of this study was to compare the rate of complications, that is, CLABSIs and catheter-related VTE associated with the use of PICCs and midline catheters.
Methods: This study was conducted at Emory University Hospital (EUH), a 500 bed teaching hospital in Atlanta, Georgia. The time period that was evaluated was March 2013 to December 2015. All PICC lines and midline catheters are placed by the vascular access team (VAT), which is comprised of 6 nurses with internal certification and national vascular access board certification.
This retrospective study was performed on all patients who had either a PICC or midline catheter placed, and then developed either symptomatic upper extremity deep vein thrombosis (DVT) or a CLABSI. Venous duplex ultrasonography dictation reports were reviewed to document the presence of DVT. In order to determine whether or not a patient had a CLABSI, the criteria that are delineated in the Centers for Disease Control “Bloodstream Infection Event (Central Line-Associated Bloodstream Infection and Non-central line-associated Bloodstream Infection) Device-associated module 2015 were implemented. PICC or midline catheter duration was calculated from the day of insertion until the day of removal.
The primary outcome measures for this study were CLABSIs or symptomatic DVT. Assessment for a CLABSI was initiated in patients when their physician or non-physician provider (NPP) was concerned about this diagnosis, due to presence of pyrexia, and pain or swelling in the upper extremity. Similarly, evaluation for DVT was prompted if any of the preceding symptoms were noted.
Results: The rate of catheter-related VTE in patients who had a PICC placed was 8.8 per 1000 catheter days, while it was 5.06 per 1000 catheter days (p = 0.0066) for patients who had a midline catheter placed. When considering CLABSI, the rate for patients who had a PICC placed was 12.87 per 1000 catheter days in comparison with a rate of 6.86 per 1000 catheter days (p < 0.0001), for patients who had a midline catheter placed.
Conclusions: This study demonstrated that the rates of both catheter-related VTE and CLABSI are considerably lower in patients who have midline catheters versus PICCs placed for long term vascular access. In view of these results, consideration should be given to preferentially utilizing midline catheters instead of PICCs for patients who require vascular access for up to 30 days.