Highlights
- •Midlines can be used for short-to medium-term peripherally-compatible therapy.
- •Few studies have compared midlines with peripherally inserted central catheters.
- •Our pilot trial found low rates of eligibility and protocol adherence.
- •Further research is needed to determine outcomes and suitability of midlines.
Abstract
Background
Midline catheter (MC) use has increased in acute-care settings, particularly for patients
with difficult venous access or requiring peripherally compatible intravenous therapy
for up-to 14 days. Our aim was to assess feasibility and generate clinical data comparing
MCs with Peripherally Inserted Central Catheters (PICCs).
Methods
A two-arm parallel group pilot randomised controlled trial (RCT), comparing MCs with
PICCs, was conducted in a large tertiary hospital in Queensland between September
2020 and January 2021. The primary outcome was study feasibility, measured against
rates of eligibility (>75%), consent (>90%), attrition (<5%); protocol adherence (>90%)
and missing data (<5%). The primary clinical outcome was all-cause device failure.
Results
In total, 25 patients were recruited. The median patient age was 59–62 years; most
patients were overweight/obese, with ≥2 co-morbidities. Primary outcomes: The eligibility
and protocol adherence criteria were not met; of 159 screened patients, only 25 (16%)
were eligible, and three patients did not receive their allocated intervention post-randomisation
(88% adherence). All-cause failure occurred in two patients allocated to MC (20%)
and one PICC (8.3%).
Conclusions
Our study found that a fully powered RCT testing MCs compared with PICCs is not currently
feasible in our setting. We recommend a robust process evaluation before the introduction
of MCs into clinical practice.
Keywords
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Article info
Publication history
Published online: May 02, 2023
Accepted:
March 31,
2023
Received in revised form:
March 27,
2023
Received:
January 23,
2023
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2023 Australasian College for Infection Prevention and Control. Published by Elsevier B.V. All rights reserved.
