Midline Catheter Placement

Background and indications

A Midline is a long peripheral venous catheter (8-20 cm) inserted at the arm under ultrasound guidance, with its tip remaining in arm veins (axillary or proximal subclavian) without reaching the superior vena cava. Unlike a PICC Line, it is not a central catheter. It is suited for intermediate-duration treatments (1-4 weeks).

Indications include: limited-duration IV antibiotic therapy (1-4 weeks), difficult venous access (obesity, sclerosed veins), treatments not requiring central access (certain antibiotics, hydration, IV analgesics).

Pre-procedure assessment

Arm venous Doppler ultrasound to verify venous patency and choose puncture site. Coagulation panel if known disorders.

Procedure

Under local anesthesia and ultrasound guidance, the basilic vein is punctured at the arm. The catheter (3-5 French) is advanced to the axillary vein. A fixation device is applied. The procedure takes 10 to 15 minutes. No fluoroscopy needed.

Results and scientific evidence

Technical success rate 98-100%. Midline has lower thrombosis and infection rates than PICC Line as it does not enter central circulation. Recommended use duration is 1 to 4 weeks.

Risks and complications

Mechanical phlebitis (5-8%), superficial venous thrombosis (< 3%), infection (< 1/1,000 days), occlusion (3-5%). Complications are generally less frequent than with central catheters.

Recovery

Immediate use. Maintenance similar to PICC Line (flushing, dressing changes). Simple and painless removal.

Practical information

The procedure is performed on an outpatient basis. It is performed by an interventional radiologist or trained nurse.