Catheter-Related BSI Risk Low for Both Midline, Peripherally Inserted Central Catheters – Renal and Urology News

Both midline catheters and peripherally inserted central catheters (PICCs) are safe and efficacious among adults receiving medium- to long-term intravenous (IV) therapy, according to study results published in JAMA Network Open.

Researchers conducted a parallel, 2-group, open-label, randomized controlled trial to compare the safety and efficacy of midline catheters with PICCs in adult patients receiving IV therapy over the course of 5 to 28 days. The primary outcome, which was evaluated via Fisher exact testing, was the occurrence of catheter-related bloodstream infection (BSI); secondary outcomes included symptomatic deep vein thrombosis (DVT) and catheter failure. Poisson regression was used to estimate incidence rate ratios (IRRs) for premature catheter removal and all-cause complications. Study patients were enrolled between October 2018 and February 2022 and randomly assigned 1:1 to either the midline catheter group or the PICC group (controls). The follow-up period was 90 days.

A total of 304 patients (mean [SD] age, 64.6 [13.5] years; women, 42.8%) were included in the analysis and assigned to the midline catheter group (n=152) or the PICC group (n=152).

No catheter-related BSI episodes occurred among patients in the midline catheter group, whereas 1 episode was observed in the PICC group (P >.99). In regard to symptomatic DVT, no episodes were observed in the midline catheter group but 2 DVT episodes were observed in the PICC group, necessitating early catheter removal in 1 patient (P =.50).

Although 90.1% of the population maintained a functional catheter for the duration of treatment, premature catheter removal was required among 20 (13.2%) patients with a midline catheter and 10 (6.6%) of those with a PICC (P =.045). Overall, premature catheter removal was significantly more common among patients with midline catheters (IRR, 2.61; 95% CI, 1.12-5.02; P =.02).

Complications occurred among 20 (13.2%) patients in the midline catheter group and 11 (7.2%) of those in the PICC group (IRR, 2.37; 95% CI, 1.12-5.02; P =.02). Of all complications, 3 (9.7%) were classified as major and 28 (90.3%) were classified as minor.

Further analysis was performed after patients were stratified by catheter dwell time. For patients with a dwell time of fewer than 16 days, no significant between-group differences were observed in the rate of any complications (IRR, 1.16; 95% CI, 0.50-2.68; P =.73) or in the need for premature catheter removal (IRR, 1.29; 95% CI, 0.54-3.06; P =.57). However, in patients with a dwell time of at least 16 days, those in the midline catheter group had significantly more complications and premature removals (IRR, 13.18; 95% CI, 1.75-99.39; P =.01).

Study limitations include low external validity, possible selection bias, the inability to blind the intervention, and potential misclassification leading to general under-reporting of outcomes in both groups.

“Further cost-effectiveness studies comparing these devices are needed to balance between catheter efficacy and economic consequences,” the researchers concluded.

This article originally appeared on Infectious Disease Advisor