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. Se tting: A 719-bed university-affiliate hospital. Patients: Patients wer e enrolled if they were likely to require at least 7 days of intravasc ular catheterization while hospitalized. Measurements: Patients were m onitored for adverse reactions, Catheter segment, insertion site, hub, infusate, and blood cultures were assessed. Results: From February 19 93 through June 1994, 251 Landmark midline catheters were inserted in 238 patients, One hundred forty catheter cultures were obtained from 1 30 patients who remained hospitalized for the duration of catheterizat ion. For these 130 patients, the mean duration of catheterization was 9 days, the incidence of catheter colonization was 5.0 per 1000 cathet er days, and the incidence of catheter-related bloodstream infection w as 0.8 per 1000 catheter days. During the study period, two severe, un expected adverse reactions occurred that may have been associated with the use of Landmark midline catheters; no such reactions were associa ted with the insertion of 58 580 Teflon peripheral catheters (P < 0.00 001; exact 95% lower bound of the odds ratio, 68.9). Fifty-three simil ar reactions associated with Landmark midline catheters, including two deaths, have been reported to the Food and Drug Administration throug h June 1994. Conclusion: The risk for midline catheter-related infecti on is low. However, Landmark midline catheters are associated with lif e-threatening adverse reactions that are probably attributable to the catheter material itself.