From the Guidelines
Peripheral IV access is generally preferred for short-term therapy (less than 7 days) with non-irritating medications, while midline catheters are suitable for intermediate therapy (1-4 weeks) and PICC lines are recommended for long-term therapy (weeks to months) or administration of vesicant medications. The choice between peripheral and midline/PICC access for intravenous therapy depends on several factors, including the expected duration of therapy, medication characteristics, and patient factors 1.
Key Considerations
- Expected duration of therapy: Peripheral IV access is preferred for short-term therapy, while midline catheters are suitable for intermediate therapy, and PICC lines are recommended for long-term therapy 1.
- Medication characteristics: Non-irritating medications can be administered through peripheral IV access, while vesicant medications or solutions with pH extremes require PICC lines 1.
- Patient factors: Poor peripheral access, need for frequent blood draws, or requirement for multiple IV medications may favor PICC placement 1.
Recommendations
- For short-term therapy (less than 7 days) with non-irritating medications, peripheral IV access is generally preferred due to lower cost, fewer complications, and simpler insertion 1.
- Midline catheters are appropriate for intermediate therapy (1-4 weeks) with non-vesicant medications 1.
- PICC lines are recommended for long-term therapy (weeks to months), administration of vesicant medications, irritants, solutions with pH extremes (<5 or >9), or solutions with high osmolarity (>900 mOsm/L) 1.
Balancing Risks and Benefits
The decision between peripheral and midline/PICC access should balance infection risk (higher with central lines) against the need for reliable access and medication compatibility with the vessel size 1. Peripheral IVs typically need replacement every 72-96 hours, while midlines and PICCs can remain in place much longer, reducing the need for repeated venipunctures and preserving peripheral veins for future access 1.
From the Research
Peripheral vs Midline Access for Intravenous Therapy
The choice between peripheral and midline (peripherally inserted central catheter, PICC) access for intravenous therapy depends on various factors, including the duration of therapy, patient condition, and potential complications.
- Complications associated with peripheral intravenous access: Studies have reported a high failure rate of peripheral intravenous catheters, ranging from 35% to 50% 2. Complications include localized infection, bacteremia, phlebitis, and infiltration or extravasation.
- Midline catheters vs PICCs: A randomized clinical trial compared the safety and efficacy of midline catheters with PICCs among adult patients receiving intravenous therapy for 5-28 days 3. The results showed a higher incidence of catheter-related complications with midline catheters compared to PICCs. However, another study found that home intravenous therapy via PICCs was safe, with fewer infections compared to hospital care 4.
- PICC complications: Studies have reported various complications associated with PICCs, including catheter occlusion, mechanical phlebitis, catheter-associated hematogenous infection, and venous thrombosis 5, 6. However, these complications can be minimized with proper nursing care and management.
- Comparison of PICCs and midlines: A retrospective review compared the incidences of infectious and thromboembolic complications between PICCs and midlines 6. The results showed no significant differences in the rates of deep venous thrombosis, sepsis, or septic shock between the two groups.
Key Considerations
When choosing between peripheral and midline access for intravenous therapy, healthcare providers should consider the following factors:
- Duration of therapy: PICCs may be more suitable for long-term therapy, while peripheral intravenous access may be preferred for short-term therapy.
- Patient condition: Patients with limited venous access or those requiring frequent blood draws may benefit from PICCs.
- Potential complications: Healthcare providers should weigh the risks and benefits of each type of access and take steps to minimize complications.