Catheter-related thromboembolism risk associated PICC and midline catheters
Abstract:
Background: Peripherally inserted central catheters (PICCs) and midline catheters (MCs) are widely used for medium- to long-term vascular access in hospitalized adults. While PICCs are associated with a known risk of venous thromboembolism (VTE), the thrombotic safety profile of MCs remains uncertain, with conflicting evidence and inconsistent definitions complicating risk assessments.
Objective: To compare the incidence of VTE, between PICCs and MCs through a systematic review and meta-analysis Methods: The primary outcome was the incidence of VTE, by catheter type. Subgroup and sensitivity analyses explored heterogeneity by insertion technique, placement setting, and publication period.
Results: A total of 29,680 catheters were included across 19 studies, comprising 14,200 MCs and 15,480 PICCs. The pooled analysis showed no statistically significant difference in overall VTE rates between MCs (3.5%) and PICCs (3.8%), with a pooled OR of 0.92 (95% CI: 0.70-1.22). Similarly, catheter-related thrombosis (CRT) rates did not differ significantly between the two device types (OR = 1.14, 95% CI: 0.74-1.76). In the subgroup of studies enrolling ≥25% of patients from intensive care units (ICUs), no significant difference in thrombotic risk was observed between MCs and PICCs (OR = 0.88, 95% CI: 0.72-1.07). No significant differences in VTE risk were observed when stratified by placement technique, clinical setting, or publication period.
Conclusions: Midline catheters demonstrated no significant differences in the thrombotic profile compared to PICCs. Therefore, VTE risk alone should not determine catheter choice. Future prospective studies with standardized definitions and improved reporting are essential to guide optimal vascular access choice.
Reference:
Santagata D, Subri F, Vegliach C, Donadini MP, Dentali F, Antonio G, Giarretta I. Venous thromboembolism risk associated with MIDLINE catheters and Peripherally Inserted Central catheters, a systematic review and meta-analysis. Thromb Haemost. 2026 Feb 12. doi: 10.1055/a-2810-4737. Epub ahead of print. PMID: 41679731.