Journal of the College of Physicians and Surgeons Pakistan
ISSN: 1022-386X (PRINT)
ISSN: 1681-7168 (ONLINE)
Affiliations
doi: 10.29271/jcpsp.2026.08.1088ABSTRACT
This observational study evaluated the clinical utility of ultrasound-guided midline catheters (MCs) for the delivery of cardiovascular medications in the cardiovascular intensive care unit (CICU). Conducted at a tertiary hospital in China between 2020 and 2022, 387 critically ill CICU patients (median age 78 years) requiring multi-drug infusions were analysed. MCs demonstrated a median dwell time of 9 days (IQR: 6-13 days), successfully administering 13 cardiovascular medications, including vasopressors and antiarrhythmics. Complication rates were remarkably low (1.3%), with two lumen occlusions, two haemorrhages, and one phlebitis. No central line-associated bloodstream infections (CLABSIs) or symptomatic thromboses occurred. Compared to central venous catheters (CVCs), MCs reduced insertion complexity and infection risk while maintaining efficacy for prolonged therapy. The findings support MCs as a safe alternative to traditional CVCs in CICU settings, particularly for elderly patients with complex comorbidities. Nurses performed most insertions (78%), highlighting procedural accessibility. This study underscores the value of ultrasound-guided MCs in optimising vascular access strategies for critical cardiovascular care.
Key Words: Midline catheter, Central venous catheter, Peripherally inserted central catheter, Cardiovascular intensive care unit.
Critically ill cardiovascular patients require reliable vascular access for prolonged infusion of high-risk medications. Intravenous catheterisation enables better fluid resuscitation, monitoring of haemodynamic indicators, and intravenous nutrition, providing a significant assurance for subsequent treatment.1 Midline catheters (MCs) positioned in deep peripheral veins offer advantages over peripheral intravenous catheters (PIVs) and central venous catheters (CVCs), including reduced phlebitis and central line-associated bloodstream infections (CLABSI) risks. 2
Despite evidence supporting the use of MCs in general intensive care units (ICUs), data specific to cardiovascular inten- sive care units (CICUs) remain scarce. This study evaluates ultrasound-guided MCs in a CICU cohort, focusing on efficacy, safety, and comparative benefits against conventional access methods.
A retrospective analysis included 387 CICU patients (April 2020 to December 2022) receiving MCs for cardiovascular medications. Exclusion criteria included pre-existing CVCs or dialysis catheters.
Polyurethane MCs (SPECATH) were inserted under ultrasound guidance into the basilic, brachial, or cephalic veins.3 Data on demographics, catheter dwell time, complications, and drug administration were extracted from electronic records. The Barthel index assessed functional status. Descriptive statistics were analysed using R v4.2.2.
The cohort (median age 78 years, 50.9% male) predominantly had mixed cardiovascular conditions (79.1%). Median Barthel index was 50 (IQR: 40-67.5), indicating moderate-to-severe functional impairment (Table I).
Median MC dwell time was 9 days (IQR: 6-13). Nurses performed 78% of insertions, primarily via the basilic vein (59.7%). Complications occurred in 1.3% of cases, with no CLABSIs or thromboses (Table II).
Ultrasound-guided MCs demonstrated exceptional safety in CICU patients, with complication rates lower than historical CVC and peripherally inserted central catheter (PICC) data.2,4,5 The absence of CLABSIs contrasts sharply with CVC-associated rates (2-5%),2 likely due to shorter dwell times and stringent catheter care. MCs also avoided thrombosis risks linked to PICCs,4 critical for anticoagulated cardiovascular patients.
The 9-day median dwell time aligns with MAGIC guidelines,6 balancing therapeutic needs and infection prevention. Success-ful vasopressor delivery (e.g., norepinephrine in 60.7% of cases) challenges assumptions that MCs are unsuitable for potent medications. Procedural accessibility—78% insertions by nurses—supports scalability in resource-limited settings.
Table I: Patient's demographics and clinical profiles.
|
Demographic's characteristics |
Total study group (n = 387) |
|
Median (IQR) |
|
|
Age |
78 (68, 82) |
|
Gender, n (%) |
Male 197 (50.9) Female 190 (49.1) |
|
Race, n (%) |
Han 374 (96.6) Others 13 (3.4) |
|
BMI |
23.44 (20.32, 26.06) |
|
Interventional operation or not, n (%) |
Yes 106 (27.4) No 281 (72.6) |
|
Type of disease, n (%) |
Ischaemic heart disease: 6 (1.6) Heart failure: 24 (6.2) Arrhythmias: 39 (10.1) Mixed: 306 (79.1) Others: 12 (3.1) |
|
The Barthel index |
50 (40, 67.5) |
Table II: Comparison of MC outcomes with CVCs and PICCs.
|
Parameter |
MC (this study) |
CVC1,2 |
PICC4,5 |
|
Midline dwell time (days), median (IQR) |
9 (6-13) |
12 (7-14) |
17 (14-30) |
|
CLABSI rate |
0% |
2–5% |
1-3% |
|
Thrombosis rate |
0% |
1–3% |
3-8% |
|
Occlusion rate |
0.5% |
1-4% |
2-5% |
|
Haemorrhage |
0.5% |
1-3% |
2.3-4.1% |
|
Phlebitis |
0.3% |
0.2-1% |
3.4-6.7% |
Limitations include the retrospective design and the absence of direct comparators. However, low complication rates and operational efficiency make MCs a pragmatic alternative to CVCs in CICUs.
Ultrasound-guided MCs provide safe, effective vascular access for critical cardiovascular therapies, minimising complications associated with traditional central lines. Their adoption in CICUs can enhance patient outcomes while reducing healthcare costs.
PATIENTS’ CONSENT:
Patients' consent was waived in accordance with the guidelines of the Non-Interventional Research Ethics Committee.
COMPETING INTEREST:
The authors declared no conflict of interest.
AUTHORS’ CONTRIBUTIONS:
FX, TX, LHZ, XX: Conceived and designed the experiments, performed the experiments, analysed and interpreted the data, and wrote the paper.
LL, XX, FL: Contributed reagents, materials, analysis tools, or data and analysed and interpreted the data.
All authors approved the final version of the manuscript to be published.
REFERENCES