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Hadaway L, Gorski LA. Infiltration and Extravasation Risk with Midline Catheters: A Narrative Literature Review. JOURNAL OF INFUSION NURSING 2024; 47:324-346. [PMID: 39250768 DOI: 10.1097/nan.0000000000000566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/11/2024]
Abstract
Midline catheters have recently gained popularity in clinical use, with a common reason being the reduction of central venous catheter use and central line-associated bloodstream infections. At the same time, the number of nononcology vesicant medications has increased, and midline catheters are frequently being used for infusions of vesicant medications. The Infusion Nurses Society (INS) Vesicant Task Force identified midline catheter use as a possible risk factor for extravasation and concluded that a thorough literature review was necessary. This review highlights the variations in catheter terminology and tip locations, the frequency of infiltration and extravasation in published studies, and case reports of infiltration and extravasation from midline catheters. It also examines the many clinical issues requiring evidence-based decision-making for the most appropriate type of vascular access devices. After more than 30 years of clinical practice with midline catheters and what appears to be a significant number of studies, evidence is still insufficient to answer questions about infusion of vesicant and irritant medications through midline catheters. Given the absence of consensus on tip location, inadequate evidence of clinical outcomes, and importance of patient safety, the continuous infusion of vesicants, all parenteral nutrition formulas, and infusates with extremes in pH and osmolarity should be avoided through midline catheters.
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Affiliation(s)
- Lynn Hadaway
- Author Affiliations: Lynn Hadaway Associates, Inc, Milner, Georgia (Hadaway); Clinical Education Specialist, Ascension at Home, Brentwood, Tennessee (Gorski)
- Lynn Hadaway, MEd, RN, CRNI, has 50 years of experience in infusion nursing and adult education. Her clinical experience comes from infusion therapy teams in multiple acute care settings. She is president of Lynn Hadaway Associates, Inc, an education and consulting company started in 1996. She has authored more than 75 published articles on infusion therapy and vascular access, written 8 textbook chapters on infusion therapy, and is the clinical editor for the book Infusion Therapy Made Incredibly Easy. She served on the Infusion Nurses Society (INS) Standards of Practice committees to revise the 2006, 2011, 2016, and 2021 documents and the committees to revise the 2014 and 2022 SHEA Compendium CLABSI chapter. She is a past chair of the INCC Board of Directors, INS Member of the Year in 2007, and adjunct associate professor at Griffith University in Queensland, Australia. Lisa A. Gorski, MS, RN, HHCNS-BC, CRNI, FAAN, served as the chairperson for the 2017 and 2024 Vesicant Task Force. She has worked for more than 40 years as a clinical nurse specialist and educator. She is the author of several books and more than 70 book chapters and journal articles. She is an INS past president (2007-2008), past chair of the INCC Board of Directors, and has served as the chair of the INS Standards of Practice Committee for the 2011, 2016, and 2021 editions and co-chair for the 2024 Standards. Ms. Gorski speaks nationally and internationally on standards development, infusion therapy/vascular access, and home health care
| | - Lisa A Gorski
- Author Affiliations: Lynn Hadaway Associates, Inc, Milner, Georgia (Hadaway); Clinical Education Specialist, Ascension at Home, Brentwood, Tennessee (Gorski)
- Lynn Hadaway, MEd, RN, CRNI, has 50 years of experience in infusion nursing and adult education. Her clinical experience comes from infusion therapy teams in multiple acute care settings. She is president of Lynn Hadaway Associates, Inc, an education and consulting company started in 1996. She has authored more than 75 published articles on infusion therapy and vascular access, written 8 textbook chapters on infusion therapy, and is the clinical editor for the book Infusion Therapy Made Incredibly Easy. She served on the Infusion Nurses Society (INS) Standards of Practice committees to revise the 2006, 2011, 2016, and 2021 documents and the committees to revise the 2014 and 2022 SHEA Compendium CLABSI chapter. She is a past chair of the INCC Board of Directors, INS Member of the Year in 2007, and adjunct associate professor at Griffith University in Queensland, Australia. Lisa A. Gorski, MS, RN, HHCNS-BC, CRNI, FAAN, served as the chairperson for the 2017 and 2024 Vesicant Task Force. She has worked for more than 40 years as a clinical nurse specialist and educator. She is the author of several books and more than 70 book chapters and journal articles. She is an INS past president (2007-2008), past chair of the INCC Board of Directors, and has served as the chair of the INS Standards of Practice Committee for the 2011, 2016, and 2021 editions and co-chair for the 2024 Standards. Ms. Gorski speaks nationally and internationally on standards development, infusion therapy/vascular access, and home health care
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Abstract
The use of midline catheters has increased to reduce excessive use of central venous access devices, and additional data on midline catheter complications are needed. This study aimed to describe midline catheter complications among hospitalized patients. This retrospective study included a random sample of 300 hospitalized patients with a midline catheter insertion in 2019. The primary outcome was a composite end point of 8 complications: occlusion, bleeding at insertion site, infiltration/extravasation, catheter-related thrombosis, accidental removal, phlebitis, hematoma, and catheter-related infection. Midline catheter failure was defined as removal prior to the end of therapy due to complications. Among 300 midline catheters, the incidence of the composite end point of 1 or more midline complications was 38% (95% confidence interval, 33%-44%). Complications included occlusion (17.0%), bleeding at insertion site (12.0%), infiltration/extravasation (10.0%), catheter-related thrombosis (4.0%), accidental removal (3.0%), phlebitis (0.3%), hematoma (0.3%), and catheter-related infection (0.3%). Midline catheter failure occurred in 16% of midline catheters (n = 48) due to infiltration/extravasation (n = 27), accidental removal (n = 10), catheter-related thrombosis (n = 9), occlusion (n = 4), and catheter-related infection (n = 1). Three catheters had 2 types of failure. The most common complications of occlusion and bleeding rarely resulted in midline catheter failure. The most common causes of midline catheter failure were infiltration/extravasation, accidental removal, and catheter-related thrombosis.
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A Retrospective Assessment of Midline Catheter Failures Focusing on Catheter Composition. JOURNAL OF INFUSION NURSING 2022; 45:270-278. [PMID: 36112875 DOI: 10.1097/nan.0000000000000484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Vascular access specialists are responsible for assessing the patient in their unique situation and determining the correct vascular access device to complete the therapeutic goal without complication or failure. This retrospective cohort study compared the failure rates of a variety of polyurethane (PU) midline catheters and a midline catheter constructed of an emerging hydrophilic biomaterial (HBM). A total of 205 patients received a midline catheter and were situationally randomized by the facility where they received it. Patients who had received a midline catheter between March 2021 and May 2021 were assessed for catheter-related failures leading to increased staff time, delays in treatment, or replacement with a new vascular access device to complete the therapy. There were 101 patients in the PU cohort and 104 patients in the HBM cohort. Comparing overall failure rates between the groups revealed a 23.8% failure rate in the PU control group and only a 3.8% failure rate in the HBM group. This suggests that a midline catheter constructed of HBM biomaterial is associated with significantly lower rates of failure, thereby improving patient experience and health care economics.
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Rizk E, Tran AT, Soto F, Putney DR, Fuentes A, Swan JT. Alteplase for the treatment of midline catheter occlusions: a retrospective, single-cohort descriptive study. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2022; 31:S6-S16. [PMID: 35856577 DOI: 10.12968/bjon.2022.31.14.s6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Despite the increasing popularity of midline catheters, data on the use of alteplase for restoring midline catheter patency is scarce. AIMS This study aimed to evaluate off-label use of alteplase for midline catheter occlusions. METHOD Adults who received alteplase into a midline catheter between January 2015 and May 2018 within a multi-hospital health system were included in this study. The primary outcome was restoration of infusion or withdrawal function from at least one lumen of a treated midline catheter. FINDINGS Following alteplase administration, withdrawal function was restored in 47% (25/53) of occlusion events, infusion function was restored in 65% (11/17) of complete occlusion events, and infusion or withdrawal function was restored in 58% (31/53) of occlusion events. Only 34% (17/50) of catheters were replaced because of malfunction. Local bleeding was documented in 9% (n=5) of occlusion events after alteplase administration. CONCLUSION Most midline catheter occlusions treated with alteplase demonstrated restoration of infusion or withdrawal function.
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Affiliation(s)
- Elsie Rizk
- Pharmacy Administrative Specialist in Clinical Research, Department of Pharmacy and Department of Surgery, Houston Methodist Hospital, Houston, Texas, USA
| | - Anh Thu Tran
- Clinical Pharmacy Fellow in Outcomes Research Department of Pharmacy and Department of Surgery, Houston Methodist Hospital, Houston, Texas, USA
| | - Frank Soto
- Registered Nurse-IR/PICC, Department of Nursing, Houston Methodist Hospital, Houston, Texas, USA
| | - David R Putney
- Clinical Pharmacy Manager, Department of Pharmacy, Houston Methodist Hospital, Houston, Texas, USA
| | - Amaris Fuentes
- Medication Safety Pharmacist, System Quality and Patient Safety, Houston Methodist, Houston, Texas, USA
| | - Joshua T Swan
- Scientist and Associate Professor of Pharmacy in Surgery and Outcomes Research, Department of Pharmacy and Department of Surgery, Houston Methodist Hospital, Houston, Texas, USA
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Nickel B. Does the Midline Peripheral Intravenous Catheter Have a Place in Critical Care? Crit Care Nurse 2021; 41:e1-e21. [PMID: 34851379 DOI: 10.4037/ccn2021818] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND The goals of infusion therapy are to preserve vascular health and safely deliver needed treatment. Achieving these goals is challenging in critical care because of the complexity of the treatment required. Daily justification of retaining an existing central venous catheter also creates urgency to change to a peripheral vascular access device. The midline catheter has had a resurgence in use because of the need for a long-term peripheral vascular access device not linked to central catheter-associated bloodstream infection risk. OBJECTIVE To review the characteristics of midline catheters, the benefits and risks of midline catheters, and current evidence regarding midline catheter use in critical care. RESULTS Research related to midline catheters has greatly expanded the body of knowledge regarding vascular access device selection and midline catheter use. DISCUSSION Although the quality and results of research on vascular access devices vary widely, a more accurate safety profile is emerging to illustrate how midline catheter use can support the goals of infusion therapy. CONCLUSIONS Optimizing vascular access device selection requires recognition that every vascular access device can cause patient harm. Although the midline catheter appears to fill an important niche in infusion therapy, use of the midline catheter should be carefully evaluated. Midline catheters should not be used as a catheter-associated bloodstream infection prevention strategy, should be inserted to administer peripherally compatible solutions, and should be considered for short-term continuous vesicant therapy only in emergent situations until more definitive vascular access can be achieved.
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Affiliation(s)
- Barb Nickel
- Barb Nickel is the critical care clinical nurse specialist for CHI Health St. Francis, Grand Island, Nebraska. She is a member of the Infusion Nurses Society Standards of Practice Committee
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