New peripherally inserted midline catheter: A better alternative for intravenous antibiotic therapy in patients with cystic fibrosis

Authors

  • Dr. Ivan R. Harwood MD,

    Corresponding author
    1. Pediatric Pulmonary Disease, University of California Medical Center, San Diego, San Diego, California
    2. Cystic Fibrosis Center, University of California Medical Center, San Diego, San Diego, California
    • Pediatric Pulmonary Disease, University of California Medical Center, San Diego, 4130 Front Street, San Diego, CA 92103
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  • Linda M. Greene RN, MSN,

    1. Cystic Fibrosis Center, University of California Medical Center, San Diego, San Diego, California
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  • Jo Ann Kozakowski-Koch BSN,

    1. Pharmacy Home Care Program, University of California Medical Center, San Diego, San Diego, California
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  • Julia S. Rasor MS

    1. Menlo Care, Inc., Menlo Park, California
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Abstract

A study was performed on outpatients with cystic fibrosis (CF) to evaluate the performance of an over-the-needle peripherally inserted midline catheter for the delivery of 2-week courses of antibiotic therapy. The midline is a 7-inch catheter inserted in the antecubital region with the tip located in the axillary region. It is made of a newly developed biomaterial that softens and expands upon contact with body fluids. The hypotheses for the study were that the midline catheter: 1) is useful for intermediate-length therapies; 2) can prevent multiple 3-day conventional peripheral catheter restarts; 3) can prevent or delay the use of more invasive central devices; 4) is comfortable for patients; and 5) is economical. A total of 41 midlines were inserted in 27 patients with an average age and weight of 22 years and 109 pounds, respectively. Prior to this study implanted ports and primarily conventional short peripheral catheters were used to administer I.V. therapy to these patients; fifty percent of these short peripheral catheters failed within 2.6 days. At 2 weeks of dwell, 80% of the midline catheters placed in these patients were still indwelling. Also, 80% of all midline catheter removals were for non-catheter-related reasons. There were no cases of midline catheter phlebitis. In contrast, the phlebitis rates published for peripherally inserted central catheters (PICCs) and conventional short peripheral catheters at 7 days of dwell are 20% and >51% respectively. The midline catheters were comfortable and well liked by most patients and became more economical than conventional peripheral catheters for therapies lasting approximately 6 days through 1 to 2 months. These data indicate that the low complication rate and the cost savings of the midline catheter make it a better alternative than conventional peripheral catheters or central devices for most I.V. antibiotic therapies lasting for 1 week or longer in patients with CF.

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