The Midline Catheter: A Clinical Review

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• 作者：Daniel Z. Adams ; MD^&lowast ; ; ; Andrew Little ; DO^&dagger ; ; Charles Vinsant ; MD^&lowast ; ; Sorabh Khandelwal ; MD^&lowast ;
• 关键词：midline catheter ; midline ; venous access devices
• 刊名：Journal of Emergency Medicine
• 出版年：2016
• 出版时间：September 2016
• 年：2016
• 卷：51
• 期：3
• 页码：252-258
• 全文大小：162 K

文摘

Venous access in the emergency department (ED) is an often under-appreciated procedural skill given the frequency of its use. The patient's clinical status, ongoing need for laboratory investigation, and intravenous therapeutics guide the size, type, and placement of the catheter. The availability of trained personnel and dedicated teams using ultrasound-guided insertion techniques in technically difficult situations may also impact the selection. Appropriate device selection is warranted on initial patient contact to minimize risk and cost.

Objective

To compare venous access device indications and complications, highlighting the use of midline catheters as a potentially cost-effective and safe approach for venous access in the ED.

Discussion

Midline catheters (MC) offer a comparable rate of device-related bloodstream infection to standard peripheral intravenous catheters (PIV), but with a significantly lower rate than peripherally inserted central catheters (PICC) and central venous catheters (CVC) (PIV 0.2/1000, MC 0.5/1000, PICC 2.1–2.3/1000, CVC 2.4–2.7/1000 catheter days). The average dwell time of a MC is reported as 7.69–16.4 days, which far exceeds PIVs (2.9–4.1 days) and is comparable to PICCs (7.3–16.6 days). Cost of insertion of a MC has been cited as comparable to three PIVs, and their use has been associated with significant cost savings when placed to avoid prolonged central venous access with CVCs or in patients with difficult-to-access peripheral veins. Placement of a MC includes modified Seldinger and accelerated, or all-in-one, Seldinger techniques with or without ultrasound guidance, with a high rate of first-attempt success.

Conclusion

The MC is a versatile venous access device with a low complication rate, long dwell time, and high rate of first-attempt placement. Its utilization in the ED in patients deemed to require prolonged hospitalization or to have difficult-to-access peripheral vasculature could reduce cost and risk to patients.