Safety and Risks Associated With Midline vs Peripherally Inserted Central Catheters

Researchers conducted a study to compare outcomes among patients who underwent placement of either a midline or peripherally inserted central catheter due to either difficult vascular access or to receive antibiotic therapy.

Midline catheters were associated with a decreased risk for bloodstream infection (BSI) and catheter occlusion when compared with peripherally inserted central catheters (PICC), according to results of a study published in JAMA Internal Medicine.

In this cohort study, researchers analyzed data from a multihospital registry on patients who underwent placement of a PICC or midline catheter for either difficult venous access or intravenous antibiotic therapy for 30 days or fewer. Primary outcomes included a composite of symptomatic catheter-associated deep vein thrombosis (DVT) or pulmonary embolism (PE), catheter-related BSI, and catheter occlusion.

Overall, data from 5758 patients with PICCs and 5105 with midline catheters were included in the final analysis. After adjustments for age, sex, comorbidities, catheter lumens, and catheter dwell times, the risk of developing a major complication was increased among patients with PICCs vs those with midline catheters (odds ratio [OR], 1.99; 95% CI, 1.61-2.47). The researchers noted that the decrease in complications between patients in the midline group vs those in the PICC group was due to decreased catheter occlusion (2.1% vs 7.0%; P <.001) and decreased BSI rates (0.4% vs 1.6%; P <.001). On analysis of time-to-event models, the risk for DVT was decreased among patients in the PICC group (hazard ratio, 0.53; 95% CI, 0.38-0.74).

On analysis of individual complications, the researchers found that the risk for both catheter occlusion (OR, 2.24; 95% CI, 1.70-2.96) and BSI (OR, 4.44; 95% CI, 2.52-7.82) was increased among patients in the PICC group. Of note, no significant differences were observed between patients in both the midline or PICC groups in regard to the occurrence of symptomatic DVT (OR, 0.93; 95% CI, 0.63-1.37) or PE (OR, 1.29; 95% CI, 0.46-3.61).

Study limitations included the potential for unmeasured confounding due to its observational design. In addition, the study did not account for differences in manufacturers, coatings, or device-specific features of the various PICC and midline catheters.

According to the researchers, “thoughtful selection between [the use of PICC and midline catheters to help balance] the risk [for DVT] appears necessary in clinical care.” They concluded that “randomized clinical trials comparing these devices are needed to help inform patient safety.”


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. Published online November 29, 2021. doi: 10.1001/jamainternmed.2021.6844