Midline catheters may reduce catheter-related bloodstream infections compared with peripherally inserted central catheters in intensive care unit patients

1. In adult patients in the intensive care unit (ICU) requiring venous access following central venous catheter (CVC) removal, midline catheters (MCs) were associated with lower catheter-related bloodstream infection (CRBSI) rates but higher chances of premature removal compared with peripherally inserted central catheters (PICCs).

Evidence Rating Level: 1 (Excellent)

Although central venous catheters are essential in ICU patients for reliable central venous access during acute critical illness for hemodynamic monitoring, rapid resuscitation, and medication delivery, they increase the risk of CRBSI and thrombosis. After CVC removal, many ICU patients still require intravenous access. Although peripheral intravenous catheters (PIVs) are safe, they are often inadequate in ICU patients. MCs (15–25 cm length, tip positioned at or below the axilla in the upper arm veins) and PICCs (> 25 cm length, tip positioned in the superior vena cava at the cavoatrial junction) are intermediate options between PIVs and CVCs. However, there is limited and conflicting data comparing their safety. This single-center retrospective cohort study included adult patients aged 16 years and older who received either MCs or PICCs within 6 hours of CVC removal. Of 494 patients included in the final analysis, 247 received MCs (mean [SD] age, 63.6 [19.2] years; 74.9% male) and 247 received PICCs (mean [SD] age, 62.7 [15] years; 56.7% male). In the MC group, the main indications for placement were antibiotics (148, 59.9%) and difficult peripheral venous access (86, 34.8%). In the PICC group, the main indications were continuation of low-dose vasopressor therapy (85, 34.4%) and antibiotics (92, 37.2%). The MC group had a significantly lower risk of CRBSI compared to the PICC group (2/200, 1.0% vs. 11/200, 5.5%; OR 5.76, 95% CI 1.26–26.34, p=0.011). In the unmatched cohort, the MC group had significantly fewer DVTs (2/247, 0.8% vs. 10/247, 4.0%; p=0.034). However, this was no longer statistically significant after matching (2/200, 1.0% vs. 8/200, 4.0%; OR 4.12, 95% CI 0.86–19.67, p=0.055). There were also no significant differences in in-hospital (13/200, 6.5% vs. 20/200, 10.0%; p=0.203) or 30-day mortality (11.5% vs. 16.0%; p=0.191). However, premature catheter removal occurred more frequently in the MC group compared to the PICC group (12.15 vs. 6.89 per 1,000 catheter-days; IRR 1.76, 95% CI 1.09–2.85, p=0.019).

Click here to read this study in BMC Infectious Diseases

Citation: Ha TBV, Nguyen DL, Le DTS, Le N, Bui TL, Tran NA, et al. Midline catheters are associated with lower catheter-related bloodstream infection but higher premature removal compared with PICCs in ICU patients following central venous catheter removal: a retrospective cohort study. BMC Infect Dis. 2026 Oct 31. doi: 10.1186/s12879-026-14734-0. Epub ahead of print.

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