Can a midline catheter cause vessel herniation after discontinuation (dc)?

Midline Catheters and Vessel Herniation After Discontinuation

There is no evidence that midline catheters cause vessel herniation after discontinuation. Based on the available guidelines and research, vessel herniation is not a documented complication associated with midline catheters 1.

Midline Catheter Complications

Midline catheters are peripheral venous access devices that:

• Are 8-25 cm in length
• Are typically placed in upper arm veins (brachial or cephalic)
• Have their distal tip ending below the axillary line
• Are suitable for therapy lasting 2-6 weeks 2

Common Complications of Midline Catheters

The most frequent complications associated with midline catheters include:

1. Minor complications (more common):

   • Catheter occlusion (17.0%)
   • Bleeding at insertion site (12.0%)
   • Infiltration/extravasation (10.0%)
   • Catheter kinking (7.0%)
   • Accidental dislodgement (8.7%) 3, 4

2. Major complications (rare):

   • Catheter-related thrombosis (0.9-4.0%)
   • Catheter-related bloodstream infections (0.3%)
   • Phlebitis (0.3%) 3, 4

Vessel herniation is not mentioned in any of the guidelines or research studies as a potential complication of midline catheters after discontinuation.

Prevention of Midline Catheter Complications

To minimize the risk of complications with midline catheters:

1. During insertion:

   • Use ultrasound guidance for placement
   • Choose the smallest gauge catheter compatible with the intended therapy
   • Select a vein with adequate diameter (catheter should be one-third or less of vein diameter)
   • Use proper aseptic technique 1

2. During maintenance:

   • Evaluate the catheter insertion site daily
   • Use appropriate nursing protocols for flushing and maintenance
   • Secure the catheter properly to prevent dislodgement
   • Monitor for signs of infection or thrombosis 1

3. Upon discontinuation:

   • Follow standard protocols for catheter removal
   • Apply pressure to the site after removal
   • Apply an appropriate dressing
   • Monitor the site for bleeding or signs of infection 1

When to Use Midline Catheters

Midline catheters are appropriate when:

• IV therapy is expected to last more than 6 days but less than 6 weeks
• Patients have difficult venous access
• Infusates are peripherally compatible (pH 5-9, osmolarity <500 mOsm)
• Central venous access is not required 1, 2

Conclusion

While midline catheters can have various complications, vessel herniation after discontinuation is not a documented complication in the medical literature. The most common complications are minor issues like occlusion, bleeding, and infiltration, with major complications like thrombosis and infection being relatively rare 3, 4.

If there are concerns about the integrity of the vessel after midline catheter removal, standard post-removal assessment should be performed, including checking for bleeding, bruising, or signs of infection at the insertion site.