Twice as many complications associated with PICCs than with midline catheters for short-term use

Reference

Swaminathan L, Flanders S, Horowitz J, Zhang Q, O'Malley M, Chopra V. Safety and outcomes of midline catheters vs peripherally inserted central catheters for patients with short-term indications. JAMA Intern Med 2022;182(1):50-58.

Synopsis

Using data collected from a 48-hospital consortium, these investigators identified hospitalized patients who received peripherally inserted central catheters (PICCs) or midline catheters during a 2-year period for either difficult venous access or the need for short-term intravenous (IV) antibiotic therapy. A total of 5758 PICCs and 5105 midlines were identified. Most midlines were inserted for difficult access or blood draws; most PICCs were inserted for IV antibiotics. The outcome of interest was a major complication, defined as a composite of symptomatic upper extremity deep venous thrombosis (DVT) or pulmonary embolism (PE), catheter-related bloodstream infection, or catheter occlusion. Median dwell time was 14 days for PICCs and 6 days for midlines. After adjustment for patient and catheter characteristics, such as Charlson comorbidity score and number of catheter lumens, patients with PICCs were more likely to develop a major complication compared with those who received midlines (odds ratio [OR] 1.99; 95% CI 1.61 - 2.47). When examining individual complications, PICCs were associated with a 2-fold risk of catheter occlusion (OR 2.24; 1.70 - 2.96) and a 4-fold risk of bloodstream infection (OR 4.44; 2.52 - 7.82) compared with midlines. No significant difference was detected in symptomatic DVT or PE between the 2 groups. However, when using a time-to-event model, PICCs were associated with a lower daily risk of DVT (hazard ratio 0.53; 0.38 - 0.74). This may be due to a similar number of thrombosis events despite a shorter catheter dwell time with midlines.