Midline venous catheters – infants

Definition

A midline venous catheter is a long (3 to 8 inches, or 7 to 20 centimeters) thin, soft plastic tube that is put into a small vein. This article addresses midline catheters in infants.

Alternative Names

Medial venous catheter – infants; MVC – infants; Midline catheter – infants; ML catheter – infants; ML – infants

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Information

WHY IS A MIDLINE VENOUS CATHETER USED?

A midline venous catheter is used when an infant needs IV fluids or medicine over a long period of time. Regular IVs only last for 1 to 3 days and need to be replaced often. Midline catheters can stay in for 2 to 4 weeks.

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Midline catheters are now often used in place of:

• Umbilical catheters, which may be placed soon after birth, but carry more risks
• Central venous lines, which are placed in a large vein near the heart, but carry more risks
• Percutaneously inserted central catheters (PICCs), which reach closer to the heart, but carry more risks

Because midline catheters do not reach beyond the armpit, they are considered safer. However, there may be some IV medicines that cannot be delivered through a midline catheter. Also, routine blood draws are not advised from a midline catheter, as opposed to the more central types of venous catheters.

HOW IS A MIDLINE CATHETER PLACED?

A midline catheter is inserted into a vein in the arm, leg, or, occasionally, scalp of the infant.

The health care provider will:

• Place the infant on the examination table
• Receive help from other trained staff who will help calm and comfort the infant
• Numb the area where the catheter will be placed
• Clean the infant’s skin with a germ-killing medicine (antiseptic)
• Make a small surgical cut and place a hollow needle into a small vein in the arm, leg, or scalp
• Place the midline catheter through the needle into a larger vein and remove the needle
• Bandage the area where catheter has been placed

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WHAT ARE THE RISKS OF HAVING A MIDLINE CATHETER PLACED?

Risks of midline venous catheterization:

• Infection. The risk is small, but increases the longer the midline catheter stays in place.
• Bleeding and bruising at the site of insertion.
• Inflammation of the vein (phlebitis).
• Movement of the catheter out of place, even out of the vein.
• Fluid leaking from the catheter into the tissues may lead to swelling and redness.
• Breaking of the catheter inside the vein (very rare).

References

Centers for Disease Control and Prevention. Summary of recommendations: intravascular catheter-related infection (BSI) prevention guidelines. www.cdc.gov/infection-control/hcp/intravascular-catheter-related-infections/summary-recommendations.html?CDC_AAref_Val=https://www.cdc.gov/infectioncontrol/guidelines/BSI/recommendations.html. Updated February 28, 2024. Accessed June 19, 2024.

Chenoweth KB, Guo J-W, Chan B. The extended dwell peripheral intravenous catheter is an alternative method of NICU intravenous access. Adv Neonatal Care. 2018;18(4):295-301. PMID: 29847401 pubmed.ncbi.nlm.nih.gov/29847401/.

Witt SH, Carr CM, Krywko DM. Indwelling vascular access devices: emergency access and management. In: Roberts JR, Custalow CB, Thomsen TW, eds. Roberts and Hedges’ Clinical Procedures in Emergency Medicine and Acute Care. 7th ed. Philadelphia, PA: Elsevier; 2019:chap 24.

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