![]() 1,2 Therefore, midline catheters may reduce the need for recannulation and thereby afford a longer dwell time. 1-3 Peripheral IV catheters have high first-attempt failure rates (26% in adults, 54% in children) and often require recannulation in larger more proximal sites. 5Ĭompared with midline catheters, peripheral IV catheters are inserted more distally and most often utilize veins of the dorsum of the hand for cannulation. 4 However, evidence evaluating the risk of catheter-related bloodstream infections (CRBSI) continues to find similar or improved rates of infection with midline catheters compared with PICCs. 3 Although some evidence has supported lower thrombosis risk with midline catheters compared with CVCs, 1 a recent systematic review of 12 studies in 40,871 patients found that risk of venous thromboembolism was significantly higher with a midline catheter compared with a PICC (3.97% versus 2.29% relative risk, 1.53 95% CI, 1.33 to 1.76 p<0.00001). Central VADs may also be more appropriate in patients needing longer-term therapy. 1 Whereas the central termination site of CVCs and PICCs provide the ability to administer a wider range of infusates (eg, vesicants), this is not recommended with VADs terminating distal to the central circulation. Because this termination site is distal to those of CVCs and peripherally inserted central catheters (PICCs), midline catheters are not considered to dwell in the central circulation. ![]() 1,3 Midline catheters are inserted peripherally into the antecubital fossa or upper arm via the basilic, cephalic, or brachial vein, and extend from 8 to 20 cm centrally, where the catheter tip terminates at or below the axillary vein. Midline catheters differ from other VADs with regard to their insertion and termination sites. This review provides an overview of midline catheters and a summary of properties that influence the determination of whether a drug is appropriate for administration via midline catheter. Therefore, questions often arise regarding the appropriateness of administering specific drugs via midline catheter. ![]() Midline catheters have properties that differ from both those of traditional peripheral IV catheters and central venous catheters (CVCs). ![]() 1,2 After their introduction in the 1950s, hypersensitivity and phlebitis reactions to the manufacturing materials led to a temporary decline in the use of midline catheters through the 1990s however, a redesign of these products in recent years has led to their renewed adoption. Midline catheters represent a unique vascular access device (VAD) for patients requiring intravenous (IV) administration of drugs or other infusates. ![]()
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