Comparison of Midline vs. Central Venous Catheter-Related Bloodstream Infections: Are Midlines Safer Than Central Venous Lines?

Abstract

BackgroundWith the rising use of midline catheters (MC), validation of their safety is essential. The objective of our study was to evaluate the incidence of bloodstream infections (BSI) and other complications related to the use of MC and central venous catheter (CVC).MethodsA retrospective cohort study was performed from May-December 2016 at Detroit Medical Center, Detroit, MI. Adult patients were eligible for inclusion if they had either MC or CVC during hospitalization. Outcomes assessed were line-related BSI per the National Healthcare Service Network (NHSN) criteria, mechanical complications (nonfunctional line due to disruption in patency or dislodging), hospital length of stay, mortality and readmission within 90 days of discharge. Statistical analysis was performed using SAS software.ResultsA total of 312 patients with MC and 215 patients with CVC were analyzed. The mean age of cohort was 57 ± 17.4 years and 52% were females. Higher catheter-related BSIs (CRBSI) were seen in patients with CVC (7/215) compared with MC (1/312); (3.3 vs. 0.3%; P = 0.009). Among the CRBSI, alternative source of infection was identified in both MC (1/1) and CVC group (2/7). Two of the 7 CVC-related BSI were reported to NHSN. More mechanical complications were seen in MC (3.5%) compared with CVC group (0.4%) (P = 0.03). Patients with CVC had higher crude mortality (14% vs 6%, P = 0.002), readmission rate (51% vs 38%, P = 0.004) and line-related readmissions (5.7% vs 0.8%, P = 0.05) compared with MC group. Multivariate analysis showed female gender (OR 0.55, 95% CI 0.38–0.81), burns (OR 0.21, 95% CI 0.06–0.74), myocardial infarction (OR 0.17, 95% CI 0.08–0.36) and stay in the intensive care unit (OR 0.60, 95% CI 0.41–0.88) had higher likelihood to receive MC while CVC was more likely to be inserted in patients with chronic kidney disease (OR 2.86, 95% CI 1.84–4.44).ConclusionPatients with chronic kidney disease are more likely to get CVC and hence particular attention should be paid to prevent BSI through appropriate catheter care. MC are more common in patients with burns, myocardial infarction and in the intensive care unit. Larger studies are needed to understand if MC or CVC are independent predictors for BSI.Disclosures All authors: No reported disclosures.