Comparing Midline and Peripherally Inserted Central Catheters – a Randomized Feasibility Trial

Objectives The most effective use of midline catheters in children is not well understood. We aimed to test the feasibility of a trial comparing peripherally inserted central catheters (PICCs) to midline catheters in hospitalized children in need of durable vascular access. Methods Our study combined a single site, randomized controlled feasibility trial and a prospective observational study comparing PICCs to midline catheters. Hospitalized children ages 2-17 years old in need of non-central, medium-term vascular access (5-14 days) were enrolled for one year; enrollment goal of 30 participants/trial arm. The primary outcome was a four-measure feasibility outcome. Secondary outcomes included time-to-device removal and all-cause failure. Multi-method approaches explored patient/family experience. Results Between 8/2022-8/2023, only 43 of 260 screened patients met eligibility criteria due to a decrease in eligible PICCs used at our site. A total of 35 patients were enrolled: 8/10 in the trial (4 in each arm) and 27/33 in the observational study (21 midline catheters, 6 PICCs). Our trial eligibility goal was not met. The other feasibility measures were met (n=10): (1) 80% of eligible patients enrolled; (2) 100% received the assigned intervention; (3) 96% of catheter inserters found the study acceptable; (4) no missing data. Conclusions Due to a decrease in PICC use for non-central, medium-term vascular access needs, a trial comparing devices may not be a practical way to assess the effective use of midline catheters in hospitalized children. Next steps may include an implementation-based study evaluating an intravenous catheter selection algorithm that incorporates midline catheters.