Comparison of Midline Venous Catheters Versus Peripherally Inserted Central Catheters for Intravenous Therapy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

In 30 seconds

This systematic review and random-effects meta-analysis compared midline venous catheters (MVCs) with peripherally inserted central catheters (PICCs) for intravenous therapy in adults and children. Seven randomized controlled trials included 910 patients. Compared with PICCs, MVCs were associated with more overall complications (RR: 2.57; 95% CI: 1.54, 4.31), more premature catheter removals, and shorter median dwell time. Differences in infection and thrombosis outcomes were not statistically significant, but low event rates and wide confidence intervals limit certainty.

Key findings

• Overall complications were more frequent with MVCs than PICCs (RR: 2.57; 95% CI: 1.54, 4.31; p = 0.0003).
• Premature catheter removal was higher with MVCs (RR: 3.91; 95% CI: 1.85, 8.27; p = 0.0004).
• Median dwell time was shorter with MVCs (WMD: -2.06; 95% CI: -3.18, -0.94; p = 0.0003).
• No significant group differences were reported for bloodstream infection, thrombosis, phlebitis, dislodgment, internal malposition, or local infection.

Why it matters

Catheter choice involves balancing therapy needs against device complications and longevity. These pooled randomized data suggest that MVCs may be more prone to mechanical problems and early removal than PICCs, while the evidence does not establish comparable safety for outcomes such as infection or thrombosis. The findings support careful interpretation rather than assuming the devices are interchangeable.

What to keep in mind

The evidence comprised seven trials, and low event rates with wide confidence intervals limited certainty for several outcomes, particularly infection and thrombosis. Some pediatric subgroup estimates were imprecise; the authors call for larger trials with longer follow-up.