risk of complications with midline catheters 877


table 2. Individual Adverse Events (n=154) No. of


Adverse Events No. Occlusiona


Symptomatic thrombosisb


Exit-site infectionc


89 57


8 All adverse eventsd 154


Complications per 1,000 MC days


1.44 0.92


0.13 2.49


Time Elapsed Between MC Positioning and Onset of AE, median d (IQR; range)


13 (6–28; 1–273) 19 (8–32; 1–307)


9 (7.8–39.8; 5–323) 14 (6–28; 1–323)


NOTE. MC, midline catheter; AE, adverse event; IQR,


interquartile range. aDefined as the complete inability to flush, infuse, or aspirate (ie, complete occlusion), or resistance with flushing and aspiration or sluggish infusion (ie, partial occlusion), or ability to flush and infuse


confirmed by ultrasound examination. cPresence of tenderness, erythema, and/or purulent discharge at the


but not aspirate (ie, persistent withdrawal occlusion).4 bDefined as the lack of flow or nonpulsatile and nonphasic flow associated with lack of compressibility of the veins, edema, and erythema of the cannulated arm.6 Symptomatic thrombosis was


catheter site.5 dConsisting of a composite of AEs: occlusion, exit-site infection, and symptomatic thrombosis.


documentation. Relevant factors that may contribute to MC- related AEs, such as recent surgery, comorbidities (ie, obesity, diabetes, nephropathies, malnourishment), or administered drugs were not collected. Moreover, we had no information on the reason for inserting a MC or on the postinsertion use and care of theMCs. The setting of AEs (ie, inpatient or outpatient) was not specified; thus, comparisons between inpatient and outpatient AEs were not possible.Wemay hypothesize that the shorter dwell time in patients with an open MC or receiving supportive therapieswas due to flushing practices thatmay need improvement (ie, positive pressure and pulsating technique), but data on the local flushing practices were not available. On


the other hand, the large, heterogeneous sample makes our findings more generalizable. In conclusion, theMCcan be considered a safe device when


inserted by trained nurses, with limited complications, even beyond the suggested period of use.


acknowledgments


Financial support: No financial support was provided relevant to this article. Potential conflicts of interest. All authors report no conflicts of interest rele- vant to this article.


Affiliations: 1. Department of Public Health and Pediatric Sciences, University of Torino, via Santena 5 bis, 10126 Torino, Italy; 2. Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Corso Bramante 88-90, 10126, Torino, Italy; 3. Azienda Socio Sanitaria Territoriale Melegnano e della Martesana, Via Pandina 1, 20070 Vizzolo Predabissi (MI), Italy; 4. Azienda Sanitaria Provinciale Potenza, via Torraca 4, 85100 Potenza, Italy; 5. Department of Clinical and Biological Sciences, University of Torino, via Santena 5 bis, 10126 Torino, Italy. Address correspondence to Sara Campagna, PhD, RN, Department of


Public Health and Pediatric Sciences, University of Torino, via Santena 5 bis, 10126 Torino, Italy (sara.campagna@unito.it).


Received January 10, 2018; accepted March 4, 2018; electronically published


April 15, 2018 © 2018 by The Society for Healthcare Epidemiology of America. All rights reserved. 0899-823X/2018/3907-0018. DOI: 10.1017/ice.2018.79


references


1. Moureau N, Trick N, Nifong T, et al. Vessel health and pre- servation (part 1): a new evidence-based approach to vascular access selection and management. J Vasc Access 2012;13:351–356.


2. Adams DZ, Little A, Vinsant C, Khandelwal S. The midline catheter: a clinical review. J Emerg Med 2016;51:252–258.


3. Maki DG, Kluger DM, Crinch CJ. The risk of bloodstream infection in adults with different intravascular devices: a systematic review of 200 published prospective studies. Mayo Clin Proc 2006;81:1159–1171.


4. Canadian Vascular Access Association (CVAA). Occlusion management guideline for central venous access devices (CVADs). JCanadVascAccAss 2013;7(Supplement 1). Available at www.improvepicc.com/uploads/.../omg_2013_final_revised.pdf.


5. O’Grady NP, Alexander M, Burns LA, et al. Guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis 2011;52:e162–e193.


6. Leung A, Heal C, Banks J, Abraham B, Capati G, Pretorius C. The incidence of peripheral catheter-related thrombosis in surgical patients. Thrombosis 2016; article ID6043427, 6, pp. doi: 10.1155/2016/6043427.


7. Lorente L, Huidobro MS, Martín MM, Jiménez A, Mora ML. Accidental catheter removal in critically ill patients: a prospective and observational study. Crit Care 2004;8:R229–233.


8. Sharp R, Esterman A, McCutcheon H, Hearse N, Cummings M. The safety and efficacy of midlines compared to peripherally inserted central catheters for adult cystic fibrosis patients: a retro- spective, observational study. Int J Nurs Stud 2014;51:694–702.


9. Xu T, Kingsley L, DiNucci S, et al. Safety and utilization of peripherally inserted central catheters versus midlinecatheters at a large academic medical center. Am J Infect Control 2016;44: 1458–1461.


10. Giuliani J, Andreetta L, Mattioli M, et al. Intravenous midline catheter usage: which clinical impact in homecare patients? J Palliat Med 2013;16:598.


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