PurposeTo determine if the use of vesicant or irritant drugs is predictive of DVT formation in patients receiving midline catheters.Materials and MethodsFrom a registry of 2522 midlines (1855 polyurethane and 667 bioflo) placed from 1/1/2013 through 12/31/2013, 93 subjects who experienced a DVT and a random sample of 186 non-DVT subjects matched in a 1:2 ratio by catheter type were analyzed. A multiple-variable logistic regression analysis was used to correlate age, gender, arm of insertion, vein of insertion, history of DVT, ICU vs. non-ICU patient location, underling clinical diagnosis and duration of insertion with the risk of DVT. Variables not achieving significance of 0.2 were excluded. A second model was then fit to test whether the presence and number of vesicant or irritant drug had an additive effect on predicting DVT risk.ResultsDVT rate was 3.7% for all midlines. There was no difference between the two catheter types (p=0.899). Significant risk factors for DVT were ICU (p=0.039), brachial vein use (p=0.015), and diagnosis of infection, inflammatory disease, cardiovascular disease, cancer, or a hypercoagulable state (p<0.001). In separate models, the use of vesicant drugs and the number of vesicants used were independent predictors of DVT (p=0.001). After adjusting for ICU, vein, diagnosis, age, and number of insertion days , the use of one or more vesicant drugs increased the risk of a DVT by 3.5 times (odds ratio = 3.5, with 95% CI of 1.68, 7.3). With the addition of each vesicant drug, the odds of DVT increased by 56% (odds ratio = 1.56, with 95% CI of 1.19, 2.04). The use of irritant drugs was not an independent predictor (p=0.111) but in a model that did not contain vesicant drug use, it also was a significant predictor (p=0.004).ConclusionDespite the increased risk of DVT in ICU patients, patients with cancer, hypercoaguability and cardiovascular disease, the use of vesicant and irritant medications in midlines significantly increased the risk of DVT. Vesicant drugs and irritant drugs should not be used in midline catheters. Patients who require these drugs should have central access. PurposeTo determine if the use of vesicant or irritant drugs is predictive of DVT formation in patients receiving midline catheters. To determine if the use of vesicant or irritant drugs is predictive of DVT formation in patients receiving midline catheters. Materials and MethodsFrom a registry of 2522 midlines (1855 polyurethane and 667 bioflo) placed from 1/1/2013 through 12/31/2013, 93 subjects who experienced a DVT and a random sample of 186 non-DVT subjects matched in a 1:2 ratio by catheter type were analyzed. A multiple-variable logistic regression analysis was used to correlate age, gender, arm of insertion, vein of insertion, history of DVT, ICU vs. non-ICU patient location, underling clinical diagnosis and duration of insertion with the risk of DVT. Variables not achieving significance of 0.2 were excluded. A second model was then fit to test whether the presence and number of vesicant or irritant drug had an additive effect on predicting DVT risk. From a registry of 2522 midlines (1855 polyurethane and 667 bioflo) placed from 1/1/2013 through 12/31/2013, 93 subjects who experienced a DVT and a random sample of 186 non-DVT subjects matched in a 1:2 ratio by catheter type were analyzed. A multiple-variable logistic regression analysis was used to correlate age, gender, arm of insertion, vein of insertion, history of DVT, ICU vs. non-ICU patient location, underling clinical diagnosis and duration of insertion with the risk of DVT. Variables not achieving significance of 0.2 were excluded. A second model was then fit to test whether the presence and number of vesicant or irritant drug had an additive effect on predicting DVT risk. ResultsDVT rate was 3.7% for all midlines. There was no difference between the two catheter types (p=0.899). Significant risk factors for DVT were ICU (p=0.039), brachial vein use (p=0.015), and diagnosis of infection, inflammatory disease, cardiovascular disease, cancer, or a hypercoagulable state (p<0.001). In separate models, the use of vesicant drugs and the number of vesicants used were independent predictors of DVT (p=0.001). After adjusting for ICU, vein, diagnosis, age, and number of insertion days , the use of one or more vesicant drugs increased the risk of a DVT by 3.5 times (odds ratio = 3.5, with 95% CI of 1.68, 7.3). With the addition of each vesicant drug, the odds of DVT increased by 56% (odds ratio = 1.56, with 95% CI of 1.19, 2.04). The use of irritant drugs was not an independent predictor (p=0.111) but in a model that did not contain vesicant drug use, it also was a significant predictor (p=0.004). DVT rate was 3.7% for all midlines. There was no difference between the two catheter types (p=0.899). Significant risk factors for DVT were ICU (p=0.039), brachial vein use (p=0.015), and diagnosis of infection, inflammatory disease, cardiovascular disease, cancer, or a hypercoagulable state (p<0.001). In separate models, the use of vesicant drugs and the number of vesicants used were independent predictors of DVT (p=0.001). After adjusting for ICU, vein, diagnosis, age, and number of insertion days , the use of one or more vesicant drugs increased the risk of a DVT by 3.5 times (odds ratio = 3.5, with 95% CI of 1.68, 7.3). With the addition of each vesicant drug, the odds of DVT increased by 56% (odds ratio = 1.56, with 95% CI of 1.19, 2.04). The use of irritant drugs was not an independent predictor (p=0.111) but in a model that did not contain vesicant drug use, it also was a significant predictor (p=0.004). ConclusionDespite the increased risk of DVT in ICU patients, patients with cancer, hypercoaguability and cardiovascular disease, the use of vesicant and irritant medications in midlines significantly increased the risk of DVT. Vesicant drugs and irritant drugs should not be used in midline catheters. Patients who require these drugs should have central access. Despite the increased risk of DVT in ICU patients, patients with cancer, hypercoaguability and cardiovascular disease, the use of vesicant and irritant medications in midlines significantly increased the risk of DVT. Vesicant drugs and irritant drugs should not be used in midline catheters. Patients who require these drugs should have central access.