From the Guidelines
PICC lines are preferred over midline catheters for infusion durations of 15 or more days due to the higher likelihood of midline catheter failure beyond this period. The main difference between a PICC line and a midline catheter is their placement and intended use in intravenous therapy. A PICC line is a longer catheter that extends from the insertion site (typically the upper arm) into the central venous system, with its tip residing in the superior vena cava near the heart. This central placement allows for administration of irritating medications, vesicants, solutions with extreme pH or osmolarity, and total parenteral nutrition, as noted in the Michigan Appropriateness Guide for Intravenous Catheters (MAGIC) study 1.
In contrast, a midline catheter is shorter, extending from the insertion site into the peripheral venous system but not reaching central circulation. The midline tip typically terminates in the basilic or cephalic vein below the axilla. Midlines are suitable for less irritating medications and solutions, with dwell times of 2-4 weeks, although they may be used for up to 4 weeks as approved by panelists in the MAGIC study 1.
Key considerations for choosing between PICC lines and midline catheters include:
- Therapy duration: PICC lines are preferred for durations of 15 or more days due to the higher risk of midline catheter failure beyond this period 1.
- Medication properties: PICC lines can administer irritating medications and vesicants, while midlines are limited to less irritating solutions.
- Patient condition: The choice between PICC lines and midline catheters should also consider patient-specific factors, such as the availability of suitable veins for insertion and the risk of complications like central line-associated bloodstream infections and thrombosis.
Overall, the selection of a PICC line or midline catheter should be guided by the specific needs of the patient and the characteristics of the infusion therapy, with a preference for PICC lines for longer durations and more complex medications, as supported by the MAGIC study 1.
From the Research
Overview of PICC Line and Midline Catheter
- A Peripherally Inserted Central Catheter (PICC) line and a midline catheter are both used for intravenous therapy, but they have distinct differences in terms of their insertion, use, and complications.
- PICC lines are inserted through a peripheral vein in the arm and guided to a central vein, where they can remain for several months 2, 3.
- Midline catheters, on the other hand, are inserted into a peripheral vein in the arm, but the tip is located in the axillary region, and they are typically used for shorter durations, up to 14 days 4, 5.
Indications and Use
- PICC lines are often used for long-term intravenous therapy, such as antibiotic treatment, chemotherapy, and parenteral nutrition, and can be placed for months 2, 3.
- Midline catheters are used for intermediate-length therapies, typically up to 14 days, and can prevent multiple restarts of conventional peripheral catheters 4, 5.
- Midline catheters have been shown to be comfortable for patients and can be more economical than conventional peripheral catheters for therapies lasting approximately 6 days to 1-2 months 5.
Complications
- Both PICC lines and midline catheters can have complications, such as catheter-related infections, thrombosis, and mechanical complications 4, 6.
- However, midline catheters have been shown to have a lower risk of phlebitis compared to PICC lines and conventional short peripheral catheters 5.
- The incidence of complications with midline catheters has been reported to be around 21 complications per 1000 catheter-days, compared to 7 complications per 1000 catheter-days with PICC lines 4.
Comparison of PICC Line and Midline Catheter
- The choice between a PICC line and a midline catheter depends on the specific needs of the patient, including the duration of therapy and the type of treatment required 4, 2.
- Midline catheters may be a better alternative for patients who require intermediate-length therapies, while PICC lines may be more suitable for patients who require long-term intravenous therapy 4, 5.