Original Investigation
Infectious Diseases
March 20, 2025
Midline Venous Catheter vs Peripherally Inserted Central Catheter for Intravenous Therapy: A Randomized Clinical Trial
Ahmed Bentridi, Marie-France Giroux, Gilles Soulez, et al
JAMA Netw Open. 2025;8(3):e251258. doi:10.1001/jamanetworkopen.2025.1258
Question Is a midline venous catheter (MVC) a noninferior alternative to a peripherally inserted central catheter (PICC) for peripheral intravenous therapy in a tertiary care center?
Findings In this randomized clinical trial involving 294 patients, the percentage of patients without venous catheter–related adverse event or dysfunction was significantly lower in the MVC group than in the PICC group, and the noninferiority of MVC could not be demonstrated.
Meaning The findings of this trial indicate that MVC was not a noninferior alternative to PICC for peripheral intravenous therapy in a tertiary care center.
Abstract
Importance Peripherally inserted central catheters (PICCs) are frequently used for peripheral intravenous therapy (IVT) that could be administered through a peripheral midline venous catheter (MVC).
Objective To assess the noninferiority of MVCs compared with PICCs as a reliable vascular access for peripheral IVT and blood draws for IVT that does not require a central VC.
Design, Setting, and Participants This randomized clinical trial was conducted in a single tertiary care center from September 2018 to March 2022. Participants were all consecutive adult patients who were referred for PICC and eligible for MVC. Patients likely to require a central VC (those in the critical care unit, those with kidney failure, or those requiring a multilumen VC) were excluded. Analyses were based on the evaluable population.
Interventions Participants were randomized 1:1 to either MVC or PICC. For the MVC group, a 20-cm-long, 4F (French), single-lumen MVC without a valve was used without fluoroscopic assistance. For the PICC group, a 4F, single-lumen PICC without a valve was positioned under fluoroscopy at the cavoatrial junction.
Main Outcomes and Measures The primary outcome was the percentage of patients without VC-related adverse events or dysfunctions requiring medical intervention during follow-up. A noninferiority test was performed to compare the proportion of adverse events or dysfunctions between the MVC and PICC groups. A noninferiority margin was set at 10% and a 5% 1-sided significance level.
Results Of the 6821 patients referred to the tertiary care center for PICC insertion, 294 (180 males [61.2%]; median [IQR] age, 56.3 [38.2-66.7] years) were randomized to receive MVCs (n = 146) or PICCs (n = 148); 135 and 137 participants, respectively, were included in data analysis after exclusion of those who did not complete follow-up. Ninety of 135 patients (66.7%) in the MVC group and 128 of 137 (93.4%) in the PICC group were without VC-related adverse event or dysfunction. The noninferiority of MVC could not be demonstrated (P > .99 for noninferiority).
Conclusions and Relevance In this randomized clinical trial, MVCs were associated with a significantly higher percentage of patients with VC-related adverse events or dysfunctions and could not be demonstrated as a noninferior alternative to PICCs.
Trial Registration ClinicalTrials.gov Identifier: NCT03502980
