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Midline catheters: an underutilized means of decreasing central venous catheter use

Background: Central line–associated blood stream infections (CLABSI) remain a substantial source of morbidity and increased health care costs in hospitalized patients. Our aim was to show that by having a dedicated team of physician assistants for the placement of midlines central venous catheters (CVCs), the number of the more typical CVCs placed could be decreased. Patients with difficult peripheral access who were given midlines had a decrease in central line days as well as the number of CVC-associated infections. Methods: A retrospective review of data regarding central line days and CLABSI collected from 2009 to 2017 was performed. In that time period, system changes including initiating CVC monitoring and teams who placed these midline venous catheters. Data from January 2016 through December 2017 pertaining to patients in the intensive care unit (ICU) and surgical wards were reviewed, comparing the overall number of CVC and midline catheters placed. Our primary endpoint was decrease in the number of central line days and consequently the number of associated complications in ICU and ward settings. Results: Midline catheters were used more often than CVCs and in both the ICU and floor setting. There was a decrease in the number of central-line days and CLABSI that corresponded to hospital system changes, including utilizing a team of trained, designated house staff and physician assistants to monitor central lines and place midline catheters sterilely in patients with difficult peripheral access. Conclusion: Our data show that with the implementation of teams to monitor CVCs and to place the midline catheters, the number of midline catheters placed increased, and patients have fewer central line days and fewer central line–associated complications.