Safety and Efficacy of

Vasopressor Administration
Through Midline Catheters: A
Retrospective Review

Nivedita Prasanna M.D.1, Naeha Haridasa B.A.2, David Yamane

M.D.3, Andrew Sparks M.S.3, Katrina Hawkins M.D.3
1, 3
Critical Care Unit, George Washington University Hospital,
Washington D.C., USA
2
George Washington University School of Medicine and Health
Sciences, Washington D.C., USA
Background

● Central or Peripheral Catheters for Initial Venous Access of ICU patients: An

RCT1
● Safety of Peripheral Intravenous Administration of Vasoactive medications 2
● Clinical and Economic Burden of Bloodstream Infections in Critical Care
patients with CVCs3
● Comparison of Complications in Midlines vs Central Venous Catheters : Are
Midlines safer than CVCs? 4
Materials/Methods

● Age > 18 years

● ICU admission (2016-2019)
● 4Fr Midline catheter
● Vasopressor Infusion
(Phenylephrine,
Norepinephrine, Epinephrine,
Angiotensin II, and
Vasopressin)
● n=248
Are midlines Easy to insert ?

First Pass Insertion Rate 242/248 (97.6%)

Technical Complications related to 0/248 (0%)

catheter (catheter or wire fracture)

Placed by trained nursing staff 208/248 (85%)

Placed by trained housestaff 31/248 (12.5%)

How much pressors were infused ?

VASOPRESSOR AVERAGE DOSE MAXIMUM DOSE

NOREPINEPHRINE (67%) 16.8 士 10.7 mcg/min 30 mcg/min

(0.24 士 0.15 mcg/kg/min) (0.4 mcg/kg/min)

EPINEPHRINE (23%) 9.1 士 6.0 mcg/min 12 mcg/min

(0.13 士 0.08 mcg/kg/min) (0.17 mcg/kg/min)

VASOPRESSIN (50%) 0.05 士 0.02 units/min 0.08 units/min

PHENYLEPHRINE (64%) 91.4 士 64.7 mcg/min 130 mcg/min

(1.3 士 0.9 mcg/kg/min) (1.87 mcg/kg/min)

ANGIOTENSIN II (2.4%) 44.9 士 34.5 ng/kg/min 80 ng/kg/min

How long were these pressors infused for?
Average Number of Days (Uninterrupted Infusion) 7.8 士 9.3 days
(Reported as Mean 士 Standard Deviation)

Where were these pressors

infused through?
 What were the adverse effects noted?

Total Early Complication

Rate = 9/248 patients
(3.6%)

Total Late Complication

Rate = 2/248 patients
(0.008%)
Results
Did we discontinue central lines early?

Eventual Central line Placement 29/248 (11.7%)

Total Midline Days 14.7 士 12.8 (maximum duration 19 days)

● In most of our patients (n=168), the midline catheter was the only IV access
the patients required for the entirety of their hospital stay.

● The integration of our Midline Catheter program reduced the rate of CLABSIs
and total CVC days at our hospital.
Limitations

● Single center retrospective design

● Results limited to device used: Bard Midline 4F
● Many more patients between Jan 2019 -Jan 2020 with midlines, not
included in the study
References :
1. Central or Peripheral Catheters for Initial
Venous Access of ICU Patients: A
Randomized Controlled Trial, Ricard,
Jean-Damien MD, PhD et al.

2. Safety of peripheral intravenous

administration of vasoactive medication.
Journal of hospital medicine, 10(9),
581-585, Cardenas‐Garcia, J., Schaub, K.
F., et al.

3. Clinical and economic burden of

bloodstream infections in critical care
patients with central venous catheters,
Steven Burnelli MD, MSCE et al.

4. Comparison of complications in midlines

versus central venous catheters: Are
midlines safer than central venous lines?,
Mushtaq et al.