THE RISK OF MIDLINE CATHETERIZATION IN HOSPITALIZED-PATIENTS - A PROSPECTIVE-STUDY

Objective: To assess the risk associated with midline catheter use in hospitalized patients. Design: Prospective, consecutive enrollment. Setting: A 719-bed university-affiliate hospital. Patients: Patients were enrolled if they were likely to require at least 7 days of intravascular catheterization while hospitalized. Measurements: Patients were monitored for adverse reactions, Catheter segment, insertion site, hub, infusate, and blood cultures were assessed. Results: From February 1993 through June 1994, 251 Landmark midline catheters were inserted in 238 patients, One hundred forty catheter cultures were obtained from 130 patients who remained hospitalized for the duration of catheterization. For these 130 patients, the mean duration of catheterization was 9 days, the incidence of catheter colonization was 5.0 per 1000 catheter days, and the incidence of catheter-related bloodstream infection was 0.8 per 1000 catheter days. During the study period, two severe, unexpected adverse reactions occurred that may have been associated with the use of Landmark midline catheters; no such reactions were associated with the insertion of 58 580 Teflon peripheral catheters (P < 0.00001; exact 95% lower bound of the odds ratio, 68.9). Fifty-three similar reactions associated with Landmark midline catheters, including two deaths, have been reported to the Food and Drug Administration through June 1994. Conclusion: The risk for midline catheter-related infection is low. However, Landmark midline catheters are associated with life-threatening adverse reactions that are probably attributable to the catheter material itself.