Clinical and Safety Concerns With Replacing Central Venous Catheters With Midline Cathers

In response to the article "Interprofessional Approach to Reducing Central Line–Associated Bloodstream Infections in a Cardiac Surgical Intensive Care Unit,"1 we commend Mazzeffi and colleagues for their interprofessional collaboration, focus on staff accountability, and use of plan-do-check-act cycle methodologies. Their case review process provides a replicable framework for infection prevention quality improvement initiatives.However, as clinicians and researchers dedicated to advancing vascular access and infusion therapy safety and patient outcomes, we are concerned by several aspects of the article, most notably the recommendation to replace "high-risk" central venous catheters (CVCs) with midline catheters in critically ill patients requiring vasopressors. The term high-risk catheter or CVC is used repeatedly before being defined on page 18. This delayed and subjective definition risks misinterpretation and inappropriate device removal or substitution without proper clinical assessment of the infusion needs or vascular preservation.The recommendation to replace CVCs with the midline peripheral catheter in critically ill patients raises significant clinical and safety concerns: Although midline and vascular access selection recommendations represent the most significant issue in the article, we also highlight the following concerns regarding evidence framing and maintenance risks:Quality improvement efforts to reduce CLABSI are essential and commendable, but recommendations, particularly those related to vascular access device selection, must be grounded in robust, contemporary evidence and articulated with precision. Misrepresentation or premature adoption of unvetted strategies, such as routine use of midline catheters for vasopressors, may place patients at increased risk of vascular injury, thrombosis, extravasation, and infection.As stewards of vascular access and infusion therapy, we urge careful consideration of the risks, appropriate patient device matching, and preservation of central venous access when clinically indicated. Our shared goal should be to reduce infection and safeguard vascular integrity across the continuum of care.