No, PICC Lines and Midline Catheters Are Fundamentally Different Devices
A PICC line and a midline catheter are NOT the same—they differ critically in tip location, which determines what can be safely infused through them. 1
Key Anatomical Differences
- PICC lines are peripherally inserted but terminate in a central vein (superior vena cava or cavoatrial junction), providing central venous access 1
- Midline catheters are peripheral devices with tips that end below the axillary line in peripheral veins (brachial or cephalic), never reaching central circulation 1, 2
- This anatomical distinction is not merely technical—it fundamentally determines what medications and solutions can be safely administered 1
Critical Clinical Implications of This Difference
What Can Be Infused
PICCs allow infusion of vesicants, irritants, and high-osmolarity solutions at any duration because the tip sits in high-flow central veins. 1 This includes:
- Parenteral nutrition 1
- Chemotherapy 1
- Vasoactive medications 1
- Any solution regardless of pH or osmolarity 1
Midline catheters are restricted to peripherally compatible infusates only (pH 5-9, osmolarity <500 mOsm/L) because they lack central access. 2 Using midlines for vesicants or irritants risks extravasation injury and is rated as inappropriate. 1
Duration of Use
- For peripherally compatible infusates lasting 6-14 days, midlines are actually preferred over PICCs due to lower complication rates 3, 4
- For durations ≥15 days, PICCs become preferred as midline failure rates increase beyond 2 weeks 1, 3
- For durations ≤5 days, neither device is appropriate—standard peripheral IVs should be used 1, 3
Complication Profile Differences
The devices have distinct risk profiles:
- Midlines have lower rates of catheter-related bloodstream infections compared to PICCs (odds ratio 0.24) 4
- Midlines have higher rates of superficial vein thrombosis (odds ratio 2.30) 4
- PICCs have fewer but more serious complications, including central line-associated bloodstream infections and deep vein thrombosis 5
Common Pitfalls to Avoid
- Never use a midline for vesicants, irritants, or high-osmolarity solutions—this is inappropriate and risks serious extravasation injury 1, 3
- Do not place PICCs for short-duration therapy (<6 days) with peripherally compatible infusates—this unnecessarily exposes patients to central line complications 1, 3
- Do not place either device in patients with advanced CKD (stage 3b or higher)—both compromise future dialysis access by damaging arm veins 1, 3
- Midlines do not require chest X-ray confirmation after placement since they never enter central circulation, unlike PICCs 2, 6
Decision Algorithm
If vesicants/irritants are needed: Use PICC at any duration 1, 3
If only peripherally compatible infusates are needed: