From the Guidelines
Midline catheters are not recommended for apheresis procedures. Apheresis requires high blood flow rates (typically 50-120 mL/min) and large-bore vascular access that midline catheters cannot safely provide. Instead, central venous catheters such as temporary dialysis catheters or permanent tunneled catheters are the appropriate choice for apheresis. These catheters are specifically designed with larger lumens to accommodate the high flow rates needed and can handle the pressure generated during the procedure. Midline catheters are peripheral devices that extend only 3-8 inches into the vasculature and terminate before the central veins, making them unsuitable for the blood volume exchange required in apheresis. Using midline catheters for apheresis could lead to catheter damage, inadequate flow rates, hemolysis, and procedure failure. Additionally, the pressure alarms on apheresis machines would likely trigger frequently with midline catheters, making the procedure inefficient or impossible. For patients requiring apheresis, consultation with vascular access specialists is essential to place the appropriate central venous access device. According to the Michigan Appropriateness Guide for Intravenous Catheters (MAGIC) 1, midline catheters may be used for up to 4 weeks, but they are not preferred for apheresis procedures. The guidelines for the prevention of intravascular catheter-related infections also suggest that midline catheters have lower rates of phlebitis and infection compared to short peripheral catheters and central venous catheters, respectively 1. However, these guidelines do not support the use of midline catheters for apheresis procedures.
Some key points to consider when deciding on the type of catheter to use for apheresis include:
- The need for high blood flow rates
- The requirement for large-bore vascular access
- The risk of catheter damage and inadequate flow rates with midline catheters
- The importance of consulting with vascular access specialists to place the appropriate central venous access device.
In terms of the specific characteristics of midline catheters, it is worth noting that they:
- Extend only 3-8 inches into the vasculature
- Terminate before the central veins
- Are peripheral devices that are not designed for high-flow procedures like apheresis.
Overall, the use of midline catheters for apheresis procedures is not recommended due to the high risk of complications and the availability of more suitable alternatives, such as central venous catheters.
From the Research
Midline Catheters for Apheresis
- Midline catheters have been successfully used for apheresis in patients undergoing collection for immune effector cell therapy, donor lymphocyte infusion, and hematopoietic progenitor cell collection 2.
- The use of midline catheters for apheresis has been shown to be feasible and generalizable to most populations requiring cellular therapy, with the potential to decrease utilization of limited healthcare resources 2.
- Midline catheters have been used effectively in healthy allogeneic donors and patients without adequate peripheral venous access for HPC collection by apheresis, avoiding the placement of a central venous catheter 3.
Safety and Efficacy
- Studies have reported no midline catheter-associated thromboses or infections in patients undergoing apheresis 2, 3.
- Midline catheters have been shown to provide safe and effective vascular access for apheresis in both children and adults 4.
- Inlet flow rates met or exceeded the recommended inlet flow rates for apheresis in children and adults, with no adverse events reported 4.
Comparison with Other Vascular Access Options
- The choice of vascular access for therapeutic apheresis depends on the indication and duration of treatment, with options including peripheral veins, central venous catheters, totally implantable ports, and arteriovenous fistulae or grafts 5.
- Midline catheters are considered a suitable option for medium-term intravenous therapy, with the majority of vascular access specialists using them in their clinical practice 6.
Clinical Practice and Recommendations
- Vascular access specialists have incorporated midline catheters into their repertoire of peripheral venous access tools, with the majority agreeing on a classification of peripheral intravenous devices based on length and tip location 6.
- The use of midline catheters for apheresis is expected to increase as the clinical community becomes more familiar with these devices 6.