Midline catheters have been around since the 1950’s and with the increasing popularity of other venous access like PICCs, many have forgotten about this viable option for venous access. So let’s take a second look…

• A midline catheter is approximately 3-8 inches long and is inserted in the antecubital area and advanced into the peripheral veins of the upper arm.

• Yes, midlines are not central venous catheters because the tip of this catheter is at or below the axillary vein and not in the superior vena cava. For this reason, midlines are considered peripheral devices.

• Consider a midline catheter for therapies anticipated to last 1-4 weeks

• What can be given via a midline catheter? Hydration, IV solutions, pain medications, select antibiotics.

• What should not be given via a midline catheter? Continuous vesicant therapy, parenteral solutions/infusates with pH <5 or >9,  and infusates with an osmolality >600mOsm/L

• Midline catheters are reported to have lower infection rates compared to PICCs.

• Most common complication reported is phlebitis (mechanical/chemical).

• Midlines are suitable for both adults and pediatric patients.Ideal for the older adult with limited venous access.

• Special considerations should be given to patient with risk of thrombosis, comprised circulation, lymphedema, or those requiring vein preservation (patients with end stage renal disease)

• Midlines are inserted by trained nurses, using strict aseptic technique and maximal barrier precautions. and ideally with ultrasound technology.

• Midlines do not require x-ray for tip confirmation unless indicated for complications experienced during insertion.

• There are several brands of midline catheters available in the US with varying configurations and materials.

It is best to assess your patients in order to determine the appropriateness of midline catheters. The midline catheter has its limitations. It is a peripheral device but it has an advantage over a short peripheral catheters because the larger diameter of the vessels in the upper arm allow for better flow rate.  It is not a substitute for a PICC or other central venous access devices because the tip is not in the SVC.