PICC versus midlines: Comparison of peripherally inserted central catheters and midline catheters with respect to incidence of thromboembolic and infectious complications

Shaoxu Bing; Carmen Smotherman; Ryan Gustavo Rodriguez; David J Skarupa; Jin Hee Ra; Marie L Crandall

doi:10.1016/j.amjsurg.2021.09.029

PICC versus midlines: Comparison of peripherally inserted central catheters and midline catheters with respect to incidence of thromboembolic and infectious complications

Am J Surg. 2022 May;223(5):983-987. doi: 10.1016/j.amjsurg.2021.09.029. Epub 2021 Sep 25.

Authors

Shaoxu Bing¹, Carmen Smotherman², Ryan Gustavo Rodriguez¹, David J Skarupa³, Jin Hee Ra⁴, Marie L Crandall⁵

Affiliations

¹ Department of Surgery, Resident, University of Florida College of Medicine Jacksonville, FL, USA.
² Biostatistician, Center for Data Solutions, University of Florida, College of Medicine Jacksonville, FL, USA.
³ Department of Surgery, Division of Acute Care Surgery, University of Florida College of Medicine, Jacksonville, FL, USA.
⁴ Department of Surgery, University of North Carolina, Chapel Hill, USA.
⁵ Department of Surgery, Division Chief, Acute Care Surgery, University of Florida College of Medicine, Jacksonville, FL, USA. Electronic address: marie.crandall@jax.ufl.edu.

PMID: 34600737
DOI: 10.1016/j.amjsurg.2021.09.029

Abstract

Introduction: To decrease the complications related to central catheters there has been an increasing utilization of peripherally inserted central catheters (PICC) and ultrasound-guided long peripheral intravenous catheters (i.e. midlines). While the complications of PICC lines are well described there is less reported data on complications related to midline catheters. Our study aims are to compare the incidences of infectious and deep venous thrombosis (DVT) and sepsis related to PICCs and Midlines.

Methods: We performed a single-center retrospective review at an academic hospital. Data were collected on patients admitted between 1/1/2014-5/31/2016. Patient demographics, hospital length of stay (LOS), and ventilator days were collected. Outcomes of interest were line-related infections and thromboembolic events after the placement of these catheters. Endpoints were compared between three groups (PICC group, midline group and PICC placement followed by midline placement group). Univariate and multivariable analyses were used to compare across the three groups.

Results: The study included 3560 unique patients with 5058 catheters. There was an increase in use of midlines over the observed study period (245% increase from the end of 2015 to the middle of 2016). We found no significant differences in the rates of DVT among the three groups (PICC 4%, midline 3% and PICC-midline 4%; p = 0.12). There were no differences across the groups for sepsis (PICC 29%, midline 27%, and PICC-midline 32%; p = 0.14) or septic shock (PICC 7%, midline 8%, and PICC-midline 6%; p = 0.39). Adjusted means LOS were higher for patients with PICC lines compared to midlines, in both females and males. PICC group stayed longer, on average, on the ventilator compared to the midline group. No other significant differences were seen among groups.

Conclusion: Increased utilization of midline catheters were not associated with decreased risk of DVT or sepsis when compared to peripherally inserted central catheters.

Keywords: Indwelling catheter; Intravenous access; Intravenous midline; PICC line; Sepsis; Thrombosis.

MeSH terms

Catheterization, Central Venous* / adverse effects
Catheterization, Peripheral* / adverse effects
Catheters
Central Venous Catheters* / adverse effects
Female
Humans
Incidence
Male
Retrospective Studies
Risk Factors
Sepsis* / epidemiology
Sepsis* / etiology