Abstract
Dear Editor:
Midline catheters are peripheral intravascular catheters (made of either silicone or a polyurethane-elastomeric hydrogel composite) commonly used in the home health care setting. They are inserted into antecubital veins and remain distal to the central veins. 1 Midline catheters offer a less invasive, cost-effective option for vascular access in some patients. 2 A retrospective analysis of homecare patients with midline positioning referred to our Local Unit Social Health (catchment area of approximately 150,000 inhabitants) was carried out from September 1, 2011 to October 15, 2012. The aim of this report was to evaluate the complications and durations of use of midline catheters in daily clinical practice with homecare patients followed at our Local Unit Social Health. No results like these have been published until now. Among 390 homecare patients referred to our Local Unit Social Health with ongoing periodic medical care, 92 patients (23.6%) have placed a midline at home. Only in 1 case the positioning of the catheter failed, because of the difficulty in finding a peripheral venous access. At last follow-up (October 2012), 70 patients (76.1%) were alive and 22 patients (23.9%) were deceased. Thirty-six patients (39.1%) had advanced cancer in best supportive care (BSC). Seventy-three patients (79.3%) placed the midline in the basilic vein, and brachial level in 19 patients (20.7%); in 86 patients (93.5%) the catheter was positioned in the right arm and in 6 patients (6.5%) in the left arm. In 7 patients (7.6%) the midline has been removed: in 4 cases (4.3%) for obstruction, in 1 case (1.1%) due to damage of the catheter, and in 2 cases (2.2%) accidentally. In no case there were infectious complications. The median duration of the catheter was 85 days (range 1–365 days). There was no statistical significance concerning a possible relationship between the positioning seat of the midline and the onset of complications, or between the presence of an advanced cancer and the onset of complications (cross-tabulation, Pearson's χ2 test). The data collected show how the placement of midline catheters represents a safe procedure with few risks and complications (e.g., infection). The midline catheter appears to be a safe method of intravenous (IV) fluid administration for patients with limited peripheral vein access who need extended IV therapy, as supported by other authors. 3 Another point concerns the duration of the catheter, which, if properly used, would seem to guarantee a good durability. The data reported, in fact, may even be improved by increasing the time of follow-up (currently about one year). A similar situation is also applicable to the complications, which may however also increase with the lengthening of the time of follow-up. Last we would also consider the economic aspect: it would be desirable to do studies of cost effectiveness in order to understand the impact of the use of the midline catheter in daily clinical practice. Finally we can conclude by saying that midline catheters fill an important niche in homecare patients. Better prospective studies are needed of sufficient size to address all potential risk factors, including insertion site and hub colonization, insertion technique, and details of follow-up care.