R.E.B.E.L.EM - February 13, 2020 - By Salim Rezaie
Background: In critically ill patients needing IV access, ultrasound has helped improve gaining access to a set of peripheral veins, located deeper in the arm. The time it takes to do this however is not insignificant but even more importantly is that once you achieve success, the line can fail due to a short catheter length. Central venous catheters, often seen as a solution to this latter issue, are not without their own risks and complications. Therefore, a nice alternative option may be a midline catheter. These catheters are not meant for fast, large volume resuscitations because they also take time to place, but also have a longer catheter length which slows down infusion rates. Midline catheters are really about having safe access that is unlikely to be dislodged. This is a great option when you have medications you want to give but not have extravasation occur (i.e. vasopressors, hypertonic saline, calcium chloride, etc.)...
Author Conclusion: “Midline catheters may present a feasible alternative to central venous access in certain critically ill ED patients.”
Clinical Take Home Point: Midline catheter placement is feasible in the ED as an alternate approach to central lines or standard US guided lines. Further research is needed to look at generalizability of placement at other institutions, time to placement and complication rates in comparison to central venous catheters."