From the Guidelines
Midline catheters are not suitable for patients with End-Stage Renal Disease (ESRD). According to the Michigan Appropriateness Guide for Intravenous Catheters (MAGIC) study 1, insertion of midline catheters into arm veins is rated as inappropriate in ESRD patients to preserve peripheral and central veins for possible hemodialysis or creation of arteriovenous fistulae and grafts.
Key Considerations
- ESRD patients require a more permanent vascular access solution, such as an arteriovenous fistula (AVF), arteriovenous graft (AVG), or a tunneled central venous catheter.
- Midline catheters are intermediate-term devices that are inadequate for hemodialysis, which requires high blood flow rates.
- For ESRD patients awaiting creation or maturation of a permanent access, a temporary dialysis catheter or a tunneled dialysis catheter would be more appropriate.
Recommendations
- Avoid using midline catheters in ESRD patients to preserve venous access for future hemodialysis or vascular access procedures.
- Consider consulting a nephrologist to discuss the possibility of drug administration during or toward the end of the dialysis procedure.
- Use tunneled small-bore central catheters or other specialized catheters designed for hemodialysis when necessary.
From the Research
Midline Catheters in ESRD Patients
- The use of midline catheters in patients with End-Stage Renal Disease (ESRD) is not directly addressed in the provided studies, which primarily focus on central venous catheters, tunneled dialysis catheters, and arteriovenous fistulas 2, 3, 4, 5.
- However, one study discusses the utility of midline intravenous catheters in critically ill emergency department patients, including their safety and effectiveness as an alternative to more invasive types of vascular access 6.
- This study found that midline catheters had a high success rate of insertion (99%) and a low rate of severe complications (0.7%), suggesting that they may be a viable option for certain patients 6.
- Nevertheless, it is essential to note that the study population was not specifically ESRD patients, and the context of use was different from the typical requirements for vascular access in hemodialysis patients.
Considerations for ESRD Patients
- ESRD patients often require long-term vascular access for hemodialysis, which poses unique challenges and risks, such as infection, thrombosis, and catheter-related complications 2, 3, 4.
- The choice of vascular access for ESRD patients should be based on individual patient needs and factors, including the presence of comorbidities, vascular anatomy, and lifestyle considerations 5.
- While midline catheters may be suitable for some patients, their use in ESRD patients would require careful evaluation and consideration of the potential risks and benefits, as well as alternative options for vascular access 2, 3, 4, 5.