Visual Abstracts

Midline catheters are alternatives to peripherally inserted central catheters for outpatient parenteral antimicrobial therapy (OPAT). Current guidelines recommend against using midline catheters for extended treatment with vancomycin due to its irritant and vesicant properties. However, evidence supporting this recommendation is limited, and whether such practice is prevalent or harmful remains unknown. We analyzed data from the Michigan Hospital Medicine Safety Consortium (HMS) to assess device-related complications among hospitalized patients receiving OPAT with and without vancomycin therapy.

Midline catheters (midlines) are increasingly used in patients with advanced chronic kidney disease (CKD). Midline recipients with advanced CKD were compared to those without advanced CKD by patient, provider, and device characteristics, and by the occurrence of acute complications including major (e.g., upper extremity deep vein thrombosis [UE-DVT] and catheter-related bloodstream infection [CRBSI]) or minor (e.g., catheter occlusion, catheter dislodgement, infiltration, superficial thrombophlebitis, and leaking at insertion site) events. Multivariable mixed effects logistic regression was used to evaluate the association between catheter-related complications and stage of CKD.

While midline vascular catheters are gaining popularity in clinical practice, patterns of use and outcomes related to these devices are not well known. Midline use and outcomes vary widely across hospitals. Although rates of major complications are low, device removal as a result of adverse events is common.