When is a midline (central catheter) placed?

From the Guidelines

A midline catheter is placed when a patient requires intermediate-term intravenous access, typically for 1-4 weeks, but does not need a central venous catheter. This is based on the most recent and highest quality study available, which recommends the use of midline catheters for up to 4 weeks 1.

Key Considerations

• Midlines are appropriate for administering antibiotics, fluids, and non-vesicant medications that are compatible with peripheral veins.
• They are inserted into peripheral veins of the upper arm (usually the basilic or cephalic vein) and advanced so the tip terminates in the proximal portion of the limb, not extending beyond the axilla.
• Midlines are particularly useful for patients with difficult venous access who would otherwise require multiple peripheral IV placements, patients needing home infusion therapy, or those requiring IV medications beyond what a standard peripheral IV can provide.

Advantages and Disadvantages

• Midlines offer advantages over peripheral IVs including longer dwell times, reduced infiltration risk, and greater patient comfort, while avoiding the complications associated with central lines such as pneumothorax and central line-associated bloodstream infections.
• However, midlines should not be used for vesicant medications, parenteral nutrition, or solutions with pH less than 5 or greater than 9, as these require central venous access 1.

Clinical Decision Making

• The decision to place a midline catheter should be based on the patient's specific needs and medical history, taking into account the potential benefits and risks of the procedure.
• As noted in the study, panelists recognized that midline catheters may be used for up to 4 weeks and are approved for such duration of use 1.

From the Research

Placement of Midline Catheters

• Midline catheters are typically placed in an upper arm vein, such as the brachial or cephalic, with the distal end below the level of the axillary line 2
• The placement of midline catheters does not require a chest X-ray to confirm placement, as the catheter does not pass through the central veins 2
• Midline catheters can be inserted at the patient's bedside and require no radiological verification after insertion 3

Indications for Midline Catheter Placement

• Midline catheters are suitable for patients who require prolonged intravenous treatment, typically for 7 days or more, with low irritant capacity fluids 2
• They are also suitable for patients with difficult vascular access or those who require repeated blood sampling 3
• Midline catheters can be used as an alternative to central venous catheters or PICC-lines when peripheral venous access is impossible or when the patient requires prolonged intravenous treatment 3

Timing of Midline Catheter Placement

• Midline catheters are typically used for 2 to 6 weeks, but can be kept in place for up to 14 days 2, 3
• They can be considered early in treatment instead of serial short peripheral IVs, as they can last longer and have a lower risk of phlebitis and infection 2, 4