Ultrasound-Guided Midline Catheters in Patients with Difficult Intravenous Access Retrospective Observational Single-Center Study
Author(s): Hakem Alomani, Abdullah Muhamed Fahleh, Hayfa Ibnouf, Abdo Saleh Hamdon, Nora Ahmed, Basim Felemban, Hani Redwan, Khaled Masaud, Claudine Neff, Saira Rafiq, Gamal Mohamed, Luluah Althukhaifi, Emad Mohammad Khadawardi, Elsaid MY
Background: Difficult intravenous access (DIVA) in inpatients is a common problem that impacts patient satisfaction and exhausts resources. A crucial operational goal is to establish a clear and cost-effective process that minimizes the number of pricks to patients, enhances patient satisfaction, and reduces costs. We aim to share our experience and the challenges with difficult IV insertions, highlighting our use of ultrasound-guided midline catheters and a nurse-led program as a novel solution for addressing this problem. To the best of our knowledge, this is the first study in our region.
Materials and Methods: The study is an observational, retrospective analysis. The Midline refers to a peripheral venous access device (PVAD), and data are collected using electronically designed templates for such procedures. We retrieved all Midline-related procedure data from our Health Technology Information Affairs (HITA) from October 01, 2021, to December 31, 2023. Inclusion criteria: all patients (adult or pediatric) with a Midline procedure note by one of (DIVA) program instructors, exclusion criteria: venous access that is non-Midline catheter procedure, Midline procedure done by a non- DIVA member.
Result: A total of 326 lines were inserted into 245 patients. 207 (64.7%) were female, and 113 (74.8%) were adults. The Successful insertion rate was 314 (96.3%), the average number of attempts was 2, and the average dwelling time was 17 days. Physicians inserted 166 (51%) of the Midlines, and nurses inserted 160 (49%). The veins that were commonly used for Midlines were as follows: Right Basilic 104 (32.7%), 97 (30.5%), left basilic, right brachial 25 (7.9%), right cephalic 29 (9.1%), left brachial 128 (8.8%), and left cephalic 32 (10.1%). Indications for Midline insertion were as follows: difficult IV access 206 (63.4%), frequent blood extraction 35 (10.8%), home care 34 (10.5%), palliative care 29 (8.9%), prolonged infusion 9 (2.8%), new oncology diagnosis 6 (1.8%), chemotherapy administration 4 (1.2%) and 2 (0.6%) were missing data. Reasons for removal were complete therapy 207 (65.8%), malfunction 44 (14%), diseased 32 (10.10%), accidental removal 22 (7%), pain and swelling 1 (0.3%), superficial vein thrombosis 8 (2.2%), and other 2 (0.60%).
Conclusion: We found that ultrasound-guided Midline catheters are feasible, relatively safe and cost-effective when used as PVAD in DIVA cases compared with the alternative central venous access devices (CVAD) at our center. The Nurse-Led, US-guided Midline catheter training program appeared to be achievable, reducing the need for rescue expert referral for PICC or CVC.