A Retrospective Study of the Utilization of Vasopressors in Midline Catheters.

Background: The midline catheter has gained popularity in the critical care setting as an alternative route of infusion to central venous catheters in recent years. This shift in practice is secondary to their ability to remain in place for up to 28 days and emerging evidence of their ability to safely infuse high-risk medications including vasopressor medications. Midline catheters are peripheral venous catheters between 10 and 25 cm in length inserted into the basilic, brachial, and cephalic veins of the upper arm and terminate in the axillary vein. This study sought to further define the safety profile of midline catheters as a route of infusion of vasopressor medications in patients and observe for potential complications.

Methods: A retrospective chart review of patients receiving vasopressor medications through midline catheters in a 33-bed intensive care unit over a period of nine months was conducted utilizing the EPIC EMR. The study utilized a convenience sampling method to collect data regarding demographics, midline catheter insertion data, length of vasopressor infusion, and presence or absence of extravasation of vasopressor medications, and other complications during time of administration and the period following discontinuation of vasopressor medications.

Results: 203 patients with midline catheters met inclusion criteria for the study over the nine-month period. Data collection yielded a total of 7,058 hours of vasopressor administration through midline catheters among the cohort with an average of 32.2 hours per patient. Norepinephrine was the most common vasopressor infused through midline catheters accounting for 5,542.8 midline hours (78.5 percent). There was no evidence of extravasation of vasopressor medications for the duration during which vasopressor medications were administered. 14 patients (6.9 percent) experienced complications prompting removal of midline catheters between 38 hours and 10 days after pressor discontinuation.

Conclusions: Due to the low rates of extravasation in midline catheters found in this study, midline catheters may serve as viable alternatives to central venous catheters for the infusion of vasopressor medications and should be considered by practitioners as a route of infusion in critically ill patients. Due to the inherent risks and barriers associated with the insertion of central venous catheters, which may delay treatment in hemodynamically unstable patients, practitioners may consider midline catheter insertion a first line route of infusion with minimal risk of vasopressor medication extravasation.