Faculty Collaboration Database

Comparing Midline and Peripherally Inserted Central Catheters: A Randomized Feasibility Trial. Hosp Pediatr 2025 Feb 01;15(2):124-134

Date

01/24/2025

Pubmed ID

39848287

DOI

10.1542/hpeds.2024-007894

Scopus ID

2-s2.0-85216871598 (requires institutional sign-in at Scopus site)

Abstract

OBJECTIVES: The most effective use of midline catheters in children is not understood. We aimed to (1) test the feasibility of a trial comparing peripherally inserted central catheters (PICCs) to midline catheters in hospitalized children in need of durable vascular access and (2) collect preliminary effectiveness data of the 2 devices.

METHODS: Our study combined a single site, randomized controlled feasibility trial (RCT, primary study) and a prospective observational study (alternative study) comparing PICCs to midline catheters. Hospitalized children aged 2 to 17 years in need of noncentral, medium-term vascular access (5-14 days) were enrolled for 1 year. The primary outcome of the RCT was a 4-measure feasibility outcome, and we had an enrollment goal of 30 participants/arm. Effectiveness outcomes (both studies) included time-to-device removal and all-cause failure.

RESULTS: Between August 2022 and August 2023, only 43 of 260 screened patients met eligibility criteria because of a decrease in eligible PICCs. A total of 35 patients were enrolled: 8 out of 10 in the RCT (4/arm) and 27 out of 33 in the alternative study (21 midline catheters, 6 PICCs). The RCT eligibility goal was not met. The other feasibility measures were met: (1) 80% of eligible patients enrolled, (2) 100% of eligible patients received the assigned intervention, (3) 96% of inserters found the study acceptable, and (4) there were no missing data.

CONCLUSIONS: Because of a decrease in PICC use for noncentral, medium-term vascular access needs, a trial comparing devices may not be practical for assessing the effective use of midline catheters in hospitalized children. Next steps may include a hybrid effectiveness-implementation study evaluating an intravenous catheter selection algorithm that incorporates midline catheters.

Author List

Burek AG, Porada K, Plunk MR, Corey Bauer S, Liegl M, Pan A, Flynn KE, Brousseau DC, Gedeit R, Ullman AJ

Authors

Sarah Bauer MD Associate Professor in the Pediatrics department at Medical College of Wisconsin
Alina G. Burek MD Associate Professor in the Pediatrics department at Medical College of Wisconsin
Kathryn Eve Flynn PhD Vice Chair, Professor in the Medicine department at Medical College of Wisconsin
Rainer G. Gedeit MD Associate Chief Medical Officer in the Children's Administration department at Children's Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Catheterization, Central Venous
Catheterization, Peripheral
Central Venous Catheters
Child
Child, Preschool
Feasibility Studies
Female
Humans
Male
Prospective Studies