Midline Catheter Dwell Time
Midline catheters do not require routine replacement to reduce infection risk and can remain in place as long as they are functioning properly without signs of complications. 1, 2
No Maximum Dwell Time Based on Duration Alone
- The CDC explicitly states that midline catheters should not be routinely replaced to prevent infection, with no predetermined maximum dwell time specified. 1, 2
- The infection risk with midline catheters does not increase with duration of catheterization, with a bloodstream infection rate of only 0.8 per 1,000 catheter-days. 2
- Prospective studies document safe use with median dwell times of 7 days and documented safe use up to 49 days. 2
- Research demonstrates midline catheters can remain in place for 2-6 weeks routinely, with some reports of safe use extending to several months (up to 365 days in palliative care settings). 3, 1
Indications-Based Removal Only
Remove the midline catheter only when specific clinical indications arise, not based on arbitrary time limits. 2
Remove immediately if any of the following develop:
- Signs of phlebitis (warmth, tenderness, erythema, palpable venous cord) 1, 2
- Evidence of infection (fever, purulent drainage, systemic symptoms) 2
- Catheter malfunction (occlusion, inability to aspirate or flush) 2
- Catheter dislodgement or damage 2
Appropriate Duration for Vabomere Administration
For patients receiving Vabomere (meropenem-vaborbactam), which is a peripherally compatible infusate:
- Midline catheters are appropriate for therapy durations of 6-14 days. 1
- For critically ill patients, midline catheters are rated as appropriate for peripherally compatible infusates when the proposed duration is 6-14 days. 1
- If therapy extends beyond 14 days, consider transitioning to a PICC line, though a well-functioning midline can remain if no complications develop. 1
Daily Monitoring Requirements
Evaluate the catheter insertion site daily by palpation through the dressing to detect tenderness. 2
- Perform visual inspection if using a transparent dressing. 1, 2
- Remove opaque dressings only if clinical signs of infection develop. 1, 2
- Assess catheter patency and flow daily. 2
Critical Pitfalls to Avoid
- Do not apply arbitrary time limits for midline removal based solely on duration, as this is not supported by evidence. 2
- Do not routinely apply prophylactic topical antimicrobials to the insertion site. 1, 2
- Do not leave the catheter in place if signs of phlebitis or infection develop—removal is mandatory, not optional. 1, 2
- Periodically reassess whether the catheter is still needed, as unnecessary catheter days increase infection risk. 2
Real-World Complication Data
Recent studies demonstrate favorable safety profiles:
- In a prospective study of 403 midline catheters in critically ill ED patients, the median dwell time was 5 days (range 2-8 days), with severe complications occurring in only 0.7% of patients. 4
- A randomized controlled trial showed median overall catheter dwell time of 7 days (range 0-60 days) with successful completion of therapy in 80.9% of patients. 5
- A 3-year retrospective study found median dwell time of 11 days with major complications (VTE or CRBSI) occurring in only 0.9% of patients. 6