From the Guidelines
A midline catheter should not remain in place for more than 14 days, as recommended by a multispecialty panel using the RAND/UCLA appropriateness method 1. This recommendation is based on the risk of complications such as infection, thrombosis, and phlebitis that increase with longer dwell times. Some key points to consider when using midline catheters include:
- The proposed duration of use is a critical factor in determining the appropriateness of midline catheter use, with panelists rating midline catheters as appropriate for 14 or fewer days of use 1.
- Regular assessment of the insertion site, flushing protocols, and proper securement are essential for maximizing the lifespan of a midline catheter.
- The catheter should be removed promptly when no longer needed or if complications develop, regardless of how long it has been in place.
- In certain situations, such as frequent phlebotomy or difficult peripheral venous access in a hospitalized patient with cancer, midline catheters may be considered appropriate for shorter durations of use 1.
From the Research
Maximum Time a Midline can be in
- The maximum time a midline can be in is not explicitly stated in the provided studies 2, 3, 4, 5, 6.
- However, the mean dwell time for midline catheters was reported to be 8.5 days in one study 5.
- Another study found that 62.8% of midline catheters lasted to therapy completion, but the maximum duration was not specified 5.
- The studies primarily focused on comparing the complications and outcomes of midline catheters with peripherally inserted central catheters (PICCs) rather than investigating the maximum dwell time of midlines 2, 3, 4.
- Therefore, there is limited information available on the maximum time a midline can be in, and further research may be necessary to determine this 2, 3, 4, 5, 6.
Complications and Outcomes
- Midline catheters were associated with a lower risk of bloodstream infection and occlusion compared to PICCs in some studies 3, 4.
- However, the risk of deep vein thrombosis (DVT) was found to be similar or greater with midlines compared to PICCs in certain studies 2, 4.
- The use of midline catheters was not associated with a decreased risk of DVT or sepsis compared to PICCs in one study 2.
- A quality improvement initiative was implemented to reduce infiltration and thrombosis complications associated with midline catheters 5.