Comparing Midline and Peripherally Inserted Central Catheters: A Randomized Feasibility Trial

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.