Midline venous catheters - infants

Definition

A midline venous catheter is a long (3 to 8 inches, or 7 to 20 centimeters) thin, soft plastic tube that is put into a small vein. It's also called a long peripheral catheter. This article addresses midline catheters in infants.

Alternative Names

Medial venous catheter - infants; MVC - infants; Midline catheter - infants; ML catheter - infants; ML - infants; Long peripheral catheter

Information

WHY IS A MIDLINE VENOUS CATHETER USED?

A midline venous catheter is used when an infant needs IV fluids or medicine over a long period of time. Regular IVs only last for 1 to 3 days and need to be replaced often. Midline catheters can stay in for 2 to 4 weeks.

Midline catheters are now often used in place of:

• Umbilical catheters, which may be placed soon after birth, but carry more risks
• Central venous lines, which are placed in a large vein near the heart, but carry more risks
• Percutaneously inserted central catheters (PICCs), which reach closer to the heart, but carry more risks

Because midline catheters do not reach beyond the armpit, they are considered safer. However, there may be some IV medicines that cannot be delivered through a midline catheter. Also, routine blood draws are not advised from a midline catheter, as opposed to the more central types of venous catheters.

HOW IS A MIDLINE CATHETER PLACED?

A midline catheter is inserted into a vein in the arm, leg, or, occasionally, scalp of the infant.

Your health care provider will:

• Place the infant on the exam table
• Receive help from other trained staff who will help calm and comfort the infant
• Clean the infant's skin with a germ-killing medicine (antiseptic)
• Place a hollow needle into a small vein in the arm, leg, or scalp
• Place the midline catheter through the needle into a larger vein and remove the needle
• Bandage the area where catheter has been placed

WHAT ARE THE RISKS OF HAVING A MIDLINE CATHETER PLACED?

Risks of midline venous catheterization:

• Infection if the midline catheter stays in place for a long time.
• Bleeding and bruising at the site of insertion.
• Inflammation of the vein (phlebitis).
• Movement of the catheter out of place, even out of the vein.
• Fluid leaking from the catheter into the tissues causing swelling and redness.
• Breaking of the catheter inside the vein (very rare).

References

Barone G, D'Andrea V, Ancora G, et al. The neonatal DAV-expert algorithm: a GAVeCeLT/GAVePed consensus for the choice of the most appropriate venous access in newborns. Eur J Pediatr. 2023;182(8):3385-3395. PMID: 37195350 pubmed.ncbi.nlm.nih.gov/37195350/.

Centers for Disease Control and Prevention website. Infection control. Summary of recommendations: guidelines for the prevention of intravascular catheter-related infections (2011). www.cdc.gov/infection-control/hcp/intravascular-catheter-related-infections/summary-recommendations.html. Updated February 28, 2024. Accessed August 5, 2024.

Chenoweth KB, Guo J-W, Chan B. The extended dwell peripheral intravenous catheter is an alternative method of NICU intravenous access. Adv Neonatal Care. 2018;18(4):295-301. PMID: 29847401 pubmed.ncbi.nlm.nih.gov/29847401/.

Leick-Rude J, Blaine T, et al. Effective use of extended well peripheral intravenous catheters in neonatal intensive care patients. Advances in neonatal care: official journal of the National Association of Neonatal Nurses, 2023;23(1), 93-101.

Romitti MG, Perez CR, Pezzotti E, Motta M, Risso FM. Long peripheral catheters in neonates: filling the gap between short peripheral catheters and epicutaneous-caval catheters? The Journal of Vascular Access. 2023;24(5):920-925. pubmed.ncbi.nlm.nih.gov/34789024/.