When is a midline catheter favored over a Peripherally Inserted Central Catheter (PICC) for long-term antibiotic administration?

From the Guidelines

Midline catheters are favored over Peripherally Inserted Central Catheters (PICCs) for long-term antibiotic administration when the duration of use is between 6 and 14 days for peripherally compatible infusions. This recommendation is based on the Michigan Appropriateness Guide for Intravenous Catheters (MAGIC) study 1, which used a multispecialty panel and the RAND/UCLA appropriateness method to evaluate the appropriateness of PICC use compared to other venous access devices.

Key Considerations

• The study found that PICC use was rated as inappropriate when the proposed duration of use was 5 or fewer days for peripherally compatible infusions 1.
• Midline catheters and ultrasonography-guided peripheral intravenous catheters were preferred to PICCs for use between 6 and 14 days 1.
• In patients with cancer, PICCs were rated as appropriate for irritant or vesicant infusion, regardless of duration 1.

Clinical Implications

• The choice between a midline catheter and a PICC should consider the duration of antibiotic therapy, the type of antibiotic, and patient-specific factors such as vascular access history and mobility needs.
• Midline catheters are suitable for shorter courses of non-vesicant antibiotics, while PICCs are preferred for longer durations or when administering vesicant or irritant antibiotics.
• The decision should prioritize minimizing complications and optimizing patient outcomes, considering the potential risks and benefits of each option.

From the Research

Comparison of Midline Catheters and PICCs

• Midline catheters are favored over Peripherally Inserted Central Catheters (PICCs) for long-term antibiotic administration in certain situations, as they can be safely and cost-efficiently used for short-term intravenous vancomycin administration 2.
• A study found that the complication rates for midline catheters and PICCs were similar, with no significant differences in total complications, phlebitis, or thrombosis 2.
• However, the insertion costs were $90.00 less per insertion in the midline group, making midline catheters a more cost-effective option for short-term antibiotic administration 2.

PICC-Related Complications

• PICCs can be associated with complications such as phlebitis, thrombosis, and infection, although the rates of these complications can be low 3, 4.
• A study found that the total complication rate for PICCs was 5.58 incidences per 1000 catheter days, with an average indwelling patency duration of 30.58 days 3.
• Another study reported that the most common complication of PICCs was phlebitis, occurring at a rate of 1 per 1,000 catheter days, while infection was rare, occurring at a rate of 0.2 per 1,000 catheter days 4.

Patient Education and Support

• Patient education and support are essential for preventing potential harm and ensuring the safe use of PICCs for long-term antibiotic administration 5.
• A study found that patient comprehension of PICC-related complications and precautions tended to improve when patients received pharmacy consultations before and after PICC-line insertion 5.
• The study also reported that patients who received at least one pharmacy consultation after PICC-line insertion were less likely to experience delayed care due to complications 5.

Rare Complications

• Rare complications of PICC placement can include arteriovenous fistula, which can require surgical repair 6.
• A case report described a patient who developed a brachial artery-to-brachial vein arteriovenous fistula after PICC line placement, highlighting the importance of careful placement and monitoring of PICCs 6.