8th World Congress on Vascular Access 2024

Prolonged administration of Intravenous Medication through Midline compared to Standard PIVC:
The PIMMS randomized controlled trial.

TriciaM Kleidon RN MNursPrac, Victoria Gibson RN GC Child Health, Paula Cattanach RN, Jessica Schults RN PhD, Ruth H Royle MEcon, Robert S Ware PhD, Nicole Marsh RN PhD, Colleen Pitt RN, Anna Dean RN, Joshua Byrnes PhD, Claire M Rickard RN PhD, Amanda J Ullman RN PhD

Background

Peripheral intravenous catheterization (PIVC) is a one of the most painful inpatient procedures across children’s hospital admissions. Approximately 30-50% of PIVCs fail (dislodgement, extravasation/infiltration, infection, device occlusion, pain, phlebitis, and thrombosis) prematurely causing interruption to therapy, pain, re-catheterization, escalation to a more invasive intravascular device, and additional healthcare costs.

Midline Catheters are a peripheral device that are an alternative to traditional PIVCs. They are a longer length device, and usually inserted in an upper arm vein with the tip terminating at or distal to the axillary vein, outside the thoracic cavity.

Purpose

•The aim of this study was to compare the clinical effectiveness and performance of midline catheters compared to PIVCs in children requiring peripherally compatible intravenous infusions for > 4 days.

•Our primary hypothesis was fewer midline catheter failures prior to treatment completion compared to PIVCs.

•Our secondary hypotheses were midline catheters would have a longer dwell, require fewer additional devices to complete treatment, greater patient and parent satisfaction and reduced healthcare costs.

Methods

•Design/setting:

•A randomized controlled trial (July 2020 - May 2022)

•In a quaternary pediatric hospital, Brisbane, Australia.

•Participants:

•Eligibility: Patients aged 1 to 18 years requiring peripherally compatible intravenous therapy for >4 days.

•Exclusion criteria: Patients were excluded if palliative, unable to provide consent (under care of social services, non-English speaking without an interpreter) or upper arm vein likely <2mm.

•Interventions:

•Patients were randomized 1:1 to receive a PIVC (standard care) or midline catheter.

•Stratified by age (< 5 years, > 5 years).

•One catheter was studied per patient.

Results – What are the findings?

Device failure was lower in Midline catheters (10 [16%]) compared to PIVCs (30 [46%]); odds ratio (OR) 0.2; 95% Confidence Interval (CI) 0.1–0.5; p = <0.001).

Midline catheters were associated with fewer insertion attempts (mean difference (MD) -0.3; 95% CI -0.5 – 0.0; p = 0.04), increased dwell time (MD 75 hours; 95% CI 34 – 117; p = <0.001), and fewer additional vascular access devices to complete treatment (MD -0.5; 95% CI -07 – -0.2; p = 0.002) compared to PIVC.

Midline catheters were associated with greater patient (9.0 vs 7.1 out of 10; p = 0.002), and parent (9.1 vs 8.2 out of 10; p = 0.02) satisfaction and lower health care costs (AU -$151.67 [US -$100.30] per person; 95% Credible Interval AU -$171.45 to AU -$131.90 [US- $113.38 to US -$74.98).

Conclusion

The results of this RCT support the use of midline catheters for 4 or more days of peripherally compatible intravenous therapies in pediatric healthcare. Use of a midline catheter significantly improved the odds of treatment completion with a single intravenous device, providing positive clinical and financial outcomes for the patient and healthcare facility, respectively.

Future directions

Further research should focus on implementation in cohorts most likely to benefit (vascular access dependent conditions) and follow up of long-term outcomes including vessel patency.

8th World Congress on Vascular Access 2024

Prolonged administration of intravenous medication through midline compared to standard PIVC: The PIMMS randomized controlled trial.

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