Incidence of fibroblastic sleeve in midline catheters: A pilot study in a non-intensive medical department

Abstract

Background:

Fibroblastic sleeve (FS) and catheter-related thrombosis (CRT) are both complications of venous access devices. The incidence of FS is higher than that of CRT in central venous catheters. There are no prospective studies in the literature evaluating the incidence of FS in midline catheters (MCs).

Objective:

The objective of this study was to evaluate the incidence of ultrasound-detectable FS and CRT after MCs insertion amongst patients admitted to an internal medicine ward. In addition, the correlations between the events observed and the position of the tip were analyzed.

Methods:

In this pilot prospective observational study, we recruited patients during a 12-month period (from May 2022 to April 2023). All MCs were inserted by ultrasound-guided venipuncture and ultrasound-based tip location. Patients were stratified according to tip location in two cohorts: “correct,” tip in the thoracic tract of the axillary vein (optimal) or tip in the subclavian vein (acceptable), and “incorrect” with tip in the transition between the axillary/subclavian veins or in the brachial tract of the axillary vein. An ultrasound scan was performed 7–10 days after insertion. Fisher’s exact test was used to assess the association between tip position and the incidence of FS or CRT.

Results:

In total, 41 patients were recruited. Follow-up ultrasound was available for 27 patients (65%) of the total sample, revealing 10 cases of FS (37%) and 2 cases of symptomatic CRT (7.4%). No cases of asymptomatic CRT have been found. Two patients who developed FS had the catheter tip in an incorrect position. In one of these patients, FS was associated with CRT. Both cases of symptomatic CRT were on prophylactic anticoagulants: the catheter tip was in the incorrect location, and catheter malfunction was reported. No statistically significant correlation was found between tip position and the development of complications.

Conclusions:

Amongst patients with MCs, the incidence of FS is higher than CRT, and it is ultrasound-detectable 1 week after insertion. In most cases, it is asymptomatic and not associated with device malfunction. Improving FS detection is key to avoid misdiagnosis and inappropriate treatment and improved management of hospitalized patients.

Keywords

Midlines catheters fibroblastic sleeve catheter-related thrombosis

Get full access to this article

View all access options for this article.

References

Pittiruti

Van Boxtel

Scoppettuolo

, et al. European recommendations on the proper indication and use of peripheral venous access devices (the ERPIUP consensus): a WoCoVA project. J Vasc Access 2023; 24(1): 165–182.

Pittiruti

Capozzoli

Manuale pratico dell’accesso venoso 2 edizione. Roma: Antonio Delfino Editore srl, 2023. p.36.

Bahl

Johnson

Mielke

, et al. Risk factors for midline catheter failure: a secondary analysis of an existing trial. Ther Clin Risk Manag 2022; 18: 999–1007.

Tomás-López

Cristóbal-Domínguez

Báez-Gurruchaga

, et al. Experience in the use of midclavicular catheters: an inception cohort study. J Clin Nurs 2022; 31(15-16): 2296–2308.

Passaro

Pittiruti

La Greca

The fibroblastic sleeve, the neglected complication of venous access devices: a narrative review. J Vasc Access 2021; 22(5): 801–813.

Boddi

Villa

Chiostri

, et al. Incidence of ultrasound-detected asymptomatic long-term central vein catheter-related thrombosis and fibrin sheath in cancer patients. Eur J Haematol 2015; 95(5): 472–479.

Trezza

Califano

Iovino

, et al. Incidence of fibroblastic sleeve and of catheter-related venous thrombosis in peripherally inserted central catheters: a prospective study on oncological and hematological patients. J Vasc Access 2021; 22(3): 444–449.

von Elm

Altman

Egger

, et al. The strengthening the reporting of observational studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol 2008; 4(10): e296–e299.

Brescia

Pittiruti

Spencer

, et al. The SIP protocol update: Eight strategies, incorporating rapid peripheral vein assessment (RaPeVA), to minimize complications associated with peripherally inserted central catheter insertion. J Vasc Access 2024; 25: 5–13.

10.

Dawson

RB.

PICC Zone Insertion Method™ (ZIM™): a systematic approach to determine the ideal insertion site for PICCs in the upper arm. JAVA 2011; 16(3): 156–165.

11.

Elli

Pittiruti

Pigozzo

, et al. Ultrasound-guided tip location of midline catheters. J Vasc Access 2020; 21(5): 764–768.

12.

Ruegg

Faucett

Choong

Emergency inserted peripheral intravenous catheters: a quality improvement project. Br J Nurs 2018; 27: S28–S30.

13.

Marsh

Webster

Larson

, et al. Observational study of peripheral intravenous catheter outcomes in adult hospitalized patients: a multivariable analysis of peripheral intravenous catheter failure. J Hosp Med 2018; 13(2): 83–89.

14.

Rodriguez-Calero

de Pedro-Gomez

Molero-Ballester

, et al. Risk factors for difficult peripheral intravenous cannulation. The PIVV2 multicentre case-control study. J Clin Med 2020; 9(3): 799.

15.

Shokoohi

Loesche

Duggan

, et al. Difficult intravenous access as an independent predictor of delayed care and prolonged length of stay in the emergency department. J Am Coll Emerg Physicians Open 2020; 1(6): 1660–1668.

16.

Miliani

Taravella

Thillard

, et al. Peripheral venous catheter-related adverse events: evaluation from a multicentre epidemiological study in France (the CATHEVAL Project). PLoS One 2017; 12(1): e0168637.

17.

Seo

Altshuler

Dubrovskaya

, et al. The safety of midline catheters for intravenous therapy at a large academic medical center. Ann Pharmacother 2020; 54(3): 232–238.

18.

Bahl

Karabon

Chu

Comparison of venous thrombosis complications in midlines versus peripherally inserted central catheters: are midlines the safer option?

Clin Appl Thromb Hemost 2019; 25: 1–8.

19.

Lisova

Hromadkova

Pavelková

, et al. The incidence of symptomatic upper limb venous thrombosis associated with midline catheter: prospective observation. J Vasc Access 2018; 19(5): 492–495.

20.

Zhao

Tian

, et al. Impact of terminal tip location of midline catheters on catheter-related complications and indwelling duration in elderly patients. Nurs Open 2023; 10(4): 2349–2356.

21.

Nickel

Gorski

Kleidon

, et al. Infusion therapy standards of Practice, 9th edition. J Infus Nurs 2024; 47(1S Suppl 1): S1–S285.

22.

Zhang

Sun

, et al. Comparison of complications and indwelling time of midline catheter at different tip locations: a systematic review and meta-analysis. J Vasc Access 2024; 25: 1757–1766.