Comparison of Complication Rates of Midline Catheter versus Peripherally Inserted Central Catheter: An Update Systematic Review and Meta-Analysis.

BACKGROUND

In this meta-analysis, we compared the clinical outcomes and complications of using midline catheters (MCs) versus peripherally inserted central catheters (PICCs) among patients undergoing intravenous therapy (IVT). Our goal was to evaluate the relative risk of complications from MCs and PICCs.

METHODS

We performed an extensive review and meta-analysis of randomized controlled trials (RCTs) and observational investigations. Literature screening was carried out using the electronic databases Embase, Ovid, Cochrane Library, PubMed, and Google Scholar from the day of database establishment till February 26, 2025. Eligible studies included those that compared complication rates among patients using either PICCs or MCs for IVT. Our primary end point was major complications, including catheter-related vein thrombosis (CRVT) and catheter-related bloodstream infection (CRBSI). Among the secondary end points were phlebitis, pain, catheter dislodgement, catheter infiltration, and total complications. All data analyses were conducted using Stata (version 14).

RESULTS

The initial screening produced 8,410 articles. Among them, only 11 studies, including 3 RCTs and 8 observational investigations, met our strict inclusion criteria. Based on our meta-analysis, MCs were associated with a significantly higher incidence of CRVT compared to PICCs (incidence rate ratio [IRR], 1.91; 95% confidence interval [CI], 1.13-3.23; P = 0.016; I2= 13.5%), but with a significantly lower incidence of CRBSI (IRR, 0.58; 95% CI, 0.37-0.91; P = 0.018; I2= 0%). Among secondary outcomes, MCs showed a markedly increased risk of infiltration (IRR, 8.41; 95% CI, 2.53-27.93; P = 0.001; I2= 0%) and total complications (IRR, 2.54; 95% CI, 1.29-5.02; P = 0.007; I2= 78.8%). No statistically significant differences were observed between MCs and PICCs in terms of phlebitis (IRR, 2.11; 95% CI, 0.78-5.68; P = 0.14; I2= 0%), dislodgement (IRR, 2.33; 95% CI, 0.58-9.33; P = 0.23; I2= 63.5%), or pain (IRR, 1.76; 95% CI, 0.49-6.38; P = 0.39; I2= 32.7%)

CONCLUSION

Our findings suggest that MCs increased the risk of CRVT and reduced the risk of CRBSI relative to PICCs. These findings can help guide future analyses and direct comparative RCTs to further characterize the efficacy and risks of PICCs versus MCs.