Vascular access device complication rates
Abstract:
Background: In this meta-analysis, we compared the clinical outcomes and complications of using midline catheters(MCs)versus peripherally inserted central catheters (PICCs) among patients undergoing intravenous therapy (IVT). Our goal was to evaluate the relative risk of complications from MCs and PICCs.
Methods: We performed an extensive review and meta-analysis of randomized controlled trials (RCTs) and observational investigations. Literature screening was carried out using the electronic databases Embase, Ovid, Cochrane Library, PubMed, and Google Scholar from the day of database establishment till Feb 26,2025. Eligible studies included those that compared complication rates among patients using either PICCs or MCs for IVT. Our primary endpoint was major complications, including catheter-related vein thrombosis (CRVT) and catheter-related bloodstream infection (CRBSI). Among the secondary endpoints were phlebitis, pain, catheter dislodgement, catheter infiltration and total complications. All data analyses were completed on the Stata (version 14, StataCorp, College Station, TX).
Results: The initial screening produced 8410 articles. Among them, only 11, including 3 RCT and 8 observational investigations, met our strict inclusion criteria. Based on our meta-analysis, MCs were associated with a significantly higher incidence of CRVT compared to PICCs (IRR, 1.91; 95% CI, 1.13-3.23; P = 0.016; I2 = 13.5%), but with a significantly lower incidence of CRBSI (IRR, 0.58; 95% CI, 0.37-0.91; P = 0.018; I2 = 0%). Among secondary outcomes, MCs showed a markedly increased risk of infiltration (IRR, 8.41; 95% CI, 2.53-27.93; P = 0.001; I2 = 0%) and total complications (IRR, 2.54; 95% CI, 1.29-5.02; P = 0.007; I2 = 78.8%). No statistically significant differences were observed between MCs and PICCs in terms of phlebitis (IRR, 2.11; 95% CI, 0.78-5.68; P = 0.14; I2 = 0%), dislodgement (IRR, 2.33; 95% CI, 0.58-9.33; P = 0.23; I2 = 63.5%), or pain (IRR, 1.76; 95% CI, 0.49-6.38; P = 0.39; I2 = 32.7%).
Conclusions: Our findings suggest that MCs increased CRVT risk and reduced the CRBSIs risk relative to PICCs. These findings can help guide future analyses and direct comparative RCTs to further characterize the efficacy and risks of PICCs vs midline catheters.
Reference:
Tian Y, Wang R, Yao X, Song P. Comparison of complication rates of Midline Catheter vs Peripherally Inserted Central Catheter: An update Systematic Review and Meta-Analysis. Ann Vasc Surg. 2026 Apr 7:S0890-5096(26)00223-2. doi: 10.1016/j.avsg.2026.03.053. Epub ahead of print. PMID: 41956153.