- •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.
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).
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.
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%).
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.
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Published online: May 02, 2023
Accepted: March 31, 2023
Received in revised form: March 27, 2023
Received: January 23, 2023
Publication stageIn Press Corrected Proof
© 2023 Australasian College for Infection Prevention and Control. Published by Elsevier B.V. All rights reserved.