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Variation in use and outcomes related to midline catheters: results from a multicentre pilot study
  1. Vineet Chopra1,2,3,
  2. Scott Kaatz4,
  3. Lakshmi Swaminathan5,
  4. Tanya Boldenow6,
  5. Ashley Snyder1,2,3,
  6. Rachel Burris1,3,
  7. Steve J Bernstein2,3,7,
  8. Scott Flanders1,3
  1. 1 The Division of Hospital Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
  2. 2 Patient Safety Enhancement Program and Center for Clinical Management Research, VA Ann Arbor Health Care System, Ann Arbor, Michigan, USA
  3. 3 The Michigan Hospital Medicine Safety Consortium, Ann Arbor, Michigan, USA
  4. 4 Department of Internal Medicine, Henry Ford Health System, Detroit, Michigan, USA
  5. 5 Department of Internal Medicine, Beaumont Hospital, Dearborn, Michigan, USA
  6. 6 St. Josephs Health Center, Ypsilanti, Michigan, USA
  7. 7 The Division of General Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
  1. Correspondence to Dr Vineet Chopra, Division of Hospital Medicine, University of Michigan, Ann Arbor, MI 48109, USA; vineetc{at}umich.edu

Abstract

Background While midline vascular catheters are gaining popularity in clinical practice, patterns of use and outcomes related to these devices are not well known.

Methods Trained abstractors collected data from medical records of hospitalised patients who received midline catheters in 12 hospitals. Device characteristics, patterns of use and outcomes were assessed at device removal or at 30 days. Rates of major (upper-extremity deep vein thrombosis [DVT], bloodstream infection [BSI] and catheter occlusion) and minor complications were assessed. χ2 tests were used to examine differences in rates of complication by number of lumens, reasons for catheter removal l, and hospital-level differences in rates of midline use.

Results Complete data on 1161 midlines representing 5%–72% of all midlines placed in participating hospitals between 1 January 2017 and 1 March 2018 were available. Most (70.8%) midlines were placed in general ward settings for difficult intravenous access (61.4%). The median dwell time of midlines across hospitals was 6 days; almost half (49%) were removed within 5 days of insertion. A major or minor complication occurred in 10.3% of midlines, with minor complications such as dislodgement, leaking and infiltration accounting for 71% of all adverse events. While rates of major complications including occlusion, upper-extremity DVT and BSI were low (2.2%, 1.4% and 0.3%, respectively), they were just as likely to lead to midline removal as minor complications (53.8% vs 52.5%, p=0.90). Across hospitals, absolute volume of midlines placed varied from 100 to 1837 devices, with corresponding utilisation rates of 0.97%–12.92% (p<0.001).

Conclusion 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.

  • healthcare quality improvement
  • patient safety
  • decision making
  • continuous quality improvement
  • Midline Catheter
  • Vascular Access
  • Appropriateness

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Footnotes

  • Contributors All authors participated equally in the design, conception, writing, analysis, drafting and final approval of the paper. VC and AS had access to the data and vouch for the integrity of the findings.

  • Funding Support for the Michigan Hospital Medicine Safety (HMS) Consortium is provided by Blue Cross and Blue Shield of Michigan (BCBSM) and Blue Care Network as part of the BCBSM Value Partnerships program. Although Blue Cross Blue Shield of Michigan and HMS work collaboratively, the opinions, beliefs and viewpoints expressed by the author do not necessarily reflect the opinions, beliefs and viewpoints of BCBSM or any of its employees.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Because the purpose of the consortium is to measure and improve the quality of existing care practices, the project received a 'Not Regulated' status from the Institutional Review Board at our hospital.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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