A midline venous catheter is a long, (3 to 8 inches, or 7 to 20 centimeters) thin, soft plastic tube that is put into a small blood vessel. This article addresses midline catheters in infants.
WHY IS A MIDLINE VENOUS CATHETER USED?
A midline venous catheter is used when an infant needs IV fluids or medicine over a long period of time. Regular IVs only last for 1 to 3 days and need to be replaced often. Midline catheters can stay in for 2 to 4 weeks.
Midline catheters are now often used in place of:
- Umbilical catheters, which may be placed soon after birth, but carry risks
- Central venous lines, which are placed in a large vein near the heart
- Percutaneously inserted central catheters (PICC), which reach closer to the heart, but also carry risks
Because midline catheters do not reach beyond the armpit, they are considered safer. However, there may be some IV medicines that cannot be delivered through a midline catheter. Also, routine blood draws are not advised from a midline catheter, whereas they can be used from the other types of venous catheters. It is possible to draw from a midline catheter if very gentle pressure is applied and a specific technique is used.
HOW IS A MIDLINE CATHETER PLACED?
A midline catheter is inserted in the veins of the arm, leg, and occasionally, scalp of the infant.
The health care provider will:
- Place the infant on the examination table
- Trained staff will help keep the infant calm
- Numb the area where the catheter will be placed
- Clean the infant's skin with a germ-killing medicine (antiseptic)
- Make a small surgical cut and place a hollow needle into a small vein in the arm, leg, or scalp
- Place the midline catheter through the needle into a larger vein and remove the needle
- Bandage the area where catheter has been placed
WHAT ARE THE RISKS OF HAVING A MIDLINE CATHETER PLACED?
Risks of midline venous catherization:
- There is a small risk for infection. The longer the midline catheter is in place, the greater the risk.
- Bleeding and bruising at the site of insertion.
- Inflammation of the vein (phlebitis).
- The catheter may get displaced and come out of the vein if the infant moves a lot.
- Fluid from the catheter may leak into the tissues leading to swelling and redness.
- Very rarely, the catheter may break inside the vein.
Medial venous catheter - infants; MVC - infants; Midline catheter - infants; ML catheter - infants; ML - infants
Centers for Disease Control and Prevention website. Guidelines for the prevention of intravascular catheter-related infections (2011). www.cdc.gov/infectioncontrol/guidelines/BSI/index.html. Updated November 5, 2015. Accessed May 16, 2018.
Elbarbary M, Pittiruti M, Lamperti M. Pediatric ultrasound-guided vascular access. In: Lumb P, Karakitsos D, eds. Critical Care Ultrasound. Philadelphia, PA: Elsevier Saunders; 2015:chap13.
Witt SH, Carr CM, Krywko DM. Indwelling vascular access devices: emergency access and management. In: Roberts JR, Custalow CB, Thomsen TW, eds. Roberts and Hedges' Clinical Procedures in Emergency Medicine and Acute Care. 7th ed. Philadelphia, PA: Elsevier; 2019:chap 24.
Review Date 7/25/2018
Updated by: Liora C. Adler, MD, Pediatric Emergency Medicine, Joe DiMaggio Children’s Hospital, Hollywood, FL. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.