Concerns With Recommendation to Use Midline Catheters for Vasopressor Administration

I am writing to share my deep concern regarding the article in the June issue by Mazzeffi et al, "Interprofessional Approach to Reducing Central Line–Associated Bloodstream Infections in a Cardiac Surgical Intensive Care Unit."1As a practicing vascular access specialist, I am concerned about the recommendation to use midline catheters for vasopressor administration. Extravasation of vesicant infusions may and have caused catastrophic injury to veins and tissues, as seen in my practice. Promoting midline catheters as a central line [catheter]–associated bloodstream infection reduction tool will inadvertently shift focus away from promoting and educating best practices for central catheter care and maintenance, which has already been proven to reduce infection rates.The article by Mazzeffi et al lacks high-quality evidence to support the safe use of vasopressors through midline catheters, especially in critically ill populations. Patient safety and vascular access decisions must be grounded in evidence-based standards and not solely on infection prevention metrics. This article is misleading the readers and will cause a false sense of safety among bedside clinicians when making critical decisions regarding the vascular needs of the critically ill population. Unfortunately, vascular access experts are not available at every facility to intervene and advocate for the correct device based on thorough review of patient history, laboratory test results, type, and duration of intravenous medications.