Impact of terminal tip location of midline catheters on catheter-related complications and indwelling duration in elderly patients.
Jing Fu, Lingling Zhao, Yingmei Tian and 3 others
PMID 36385582WHAT IT FOUND
In older patients with midline catheters, a deeper tip near the clavicle stayed in longer and had fewer complications than a shallower tip, but the comparison was not randomised.
Key findings
01Elderly patients whose midline catheter tip was placed deeper had a median indwell duration of 29 days, compared with 18.5 days when the tip was more superficial (p = .014).
02Catheter-related complications occurred in 10 patients in the superficial group and 4 in the deep group, with a significantly higher incidence in the superficial group (p = .026).
03When complications occurred, they appeared later in the deep-tip group (day 96) than in the superficial-tip group (day 14), p = 0.003.
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How it was doneWhat they foundWhat it means for RNs
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What it does not show
Patients were not randomised to tip position, so other differences between groups may explain the results. This was a small single-centre study of 95 patients, and the authors say it could not account for all confounding variables, including illness severity and medication. Only patients receiving non-vesicant liquids with a pH between 5 and 9 and an osmotic pressure below 900 mmos/L were included, so it does not show what happens with irritant or vesicant infusions. Two deep-tip patients developed catheter-related venous thrombosis, and both had several high-risk factors, so the risk-benefit of deep placement may differ in patients at high thrombosis risk.
Declared interests
This work was supported by grants from the Science and Technology Research Plan of Shandong Province (grant number 2019GSF108114) and the Shandong Natural Science Foundation (grant number ZR2020MH033).
The easy way to misread this
Do not read this as proof that a deeper tip causes fewer complications or is safe for all older patients, because the study was non-randomised, small, and two deep-tip patients developed catheter-related venous thrombosis.