Vasopressor administration through a midline catheter
Abstract:
Rationale: Little is known about the safety of infusing vasopressors through a midline catheter.
Objectives: To evaluate safety outcomes following vasopressor administration though a midline.
Methods: We conducted a cohort study of adults admitted to 39 hospitals in Michigan (December 2017 – March 2022) who received vasopressors while either a midline or peripherally inserted central catheter (PICC) was in place. Patients receiving vasopressors through a midline were compared to those receiving vasopressors through a PICC and, separately, to those with midlines in place but who received vasopressors through a different catheter. We used descriptive statistics to characterize and compare cohort characteristics. Multivariable mixed effects logistic regression models were fit to determine the association between vasopressor administration through a midline with outcomes, primarily catheter-related complications (bloodstream infection, superficial thrombophlebitis, exit site infection, or catheter occlusion).
Results: Our cohort included 287 patients with midlines through which vasopressors were administered, 1660 with PICCs through which vasopressors were administered, and 884 patients with midlines who received vasopressors through a separate catheter. Age (median [interquartile range]: 68.7 [58.6-75.7], 66.6 [57.1-75.0], and 67.6 [58.7-75.8] years) and gender (percent female: 50.5%, 47.3%, and 43.8%) were similar in all groups. The frequency of catheter-related complications was lower in patients with midlines used for vasopressors than PICCs used for vasopressors (5.2% vs. 13.4%, p<0.001), but similar to midlines with vasopressor administration through a different device (5.2% vs. 6.3%, p=0.49). Following adjustment, administration of vasopressors through a midline was not associated with catheter-related complications compared to PICCs with vasopressors (adjusted odds ratios [aOR] 0.65 [95% confidence interval, 0.31-1.33], p=0.23), nor midlines with vasopressors elsewhere (aOR 0.85 [0.46-1.58], p=0.59). Midlines used for vasopressors were associated with greater risk of systemic thromboembolism (vs PICCs with vasopressors: (aOR 2.69 [1.31,5.49] , p=0.008; vs midlines with vasopressors elsewhere: aOR 2.42 [1.29,4.54], p=0.008) yet not thromboses restricted to the ipsilateral upper extremity (vs PICCs with vasopressors: aOR 2.35 [0.83,6.63], p=0.10; model did not converge for vs midlines with vasopressors elsewhere).
Conclusions: We found no significant association of vasopressor administration though a midline with catheter-related complications. However, we identified an increased odds of systemic (but not ipsilateral upper extremity) venous thromboembolism warranting further evaluation.
Reference:
Gershengorn HB, Basu T, Horowitz JK, McLaughlin E, Munroe E, O’Malley M, Hsaiky L, Flanders SA, Bernstein SJ, Paje D, Chopra V, Prescott HC. The Association of Vasopressor Administration Through a Midline Catheter with Catheter-Related Complications. Ann Am Thorac Soc. 2023 Feb 27. doi: 10.1513/AnnalsATS.202209-814OC. Epub ahead of print. PMID: 37166852.