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What’s New in the Patient Safety World

December 2021

Midline Catheters vs PICC’s



PICC’s (peripherally inserted central catheters) have an important place in our ability to deliver necessary treatments to patients. But they also have some downsides that we’ve highlighted in our multiple prior columns listed below.


A new study looked at the comparative safety of PICC’s vs. midline catheters in patients who had a PICC vs midline catheter placed for the indication of difficult vascular access or antibiotic therapy for 30 or fewer days (Swaminathan 2021). Perhaps somewhat surprisingly, PICC’s were associated with almost twice the risk of major complication compared to midline catheters (odds ratio, 1.99). The reduction in complications was primarily due to lower rates of occlusion (2.1% vs 7.0%; P < .001) and bloodstream infection (0.4% vs 1.6%; P < .001) in midlines vs PICC’s.


The results regarding DVT, however, were less clear. After adjusting for patient, device, and hospital characteristics, there was no statistically significant difference between the overall risk of DVT or PE. However, when examining time-to-event models, midline catheters appeared to be associated with greater daily hazard of DVT, potentially owing to a similar number of events occurring within a shorter catheter dwell time associated with these devices. The authors caution that this finding serves as a reminder to not dismiss the risk of thrombosis associated with midlines, especially in patients with hypercoagulability or preexisting risk factors for DVT, such as cancer.


The authors note that MAGIC (the Michigan Appropriateness Guide for Intravenous Catheters) (Chopra 2015) recommends midlines as the preferred vascular access in patients with difficult vascular access, for treatment thatwill likely exceed 6 days, and for patients requiring infusions including antibiotics for up to 14 days and that the results of their study support the MAGIC guideiines.



Some of our other columns on IV access, central venous catheters and PICC lines:


January 21, 2014         The PICC Myth

December 2014           Surprise Central Lines

July 2015                    Reducing Central Venous Catheter Use

October 2015              Michigan Appropriateness Guide for Intravenous Catheters

March 27, 2018           PICC Use Persists

February 26, 2019       Vascular Access Device Dislodgements

July 16, 2019              Avoiding PICC’s in CKD

March 2, 2021             Barriers to Timely Catheter Removal







Swaminathan L, Flanders S, Horowitz J, Zhang Q, O’Malley M, Chopra V. Safety and Outcomes of Midline Catheters vs Peripherally Inserted Central Catheters for Patients With Short-term Indications: A Multicenter Study. JAMA Intern Med 2021; Published online November 29, 2021



Chopra V, Flanders SA, Saint S, et al; Michigan Appropriateness Guide for Intravenouse Catheters (MAGIC) Panel. The Michigan Appropriateness Guide for Intravenous Catheters (MAGIC): results from a multispecialty panel using the RAND/UCLA appropriateness method. Ann Intern Med 2015; 163(6)(suppl): S1-S40





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