Ultrasound-guided placement of Midline catheters performed by Neurosurgery resident as a substitute for conventional central venous catheter placement in Neurosurgical Intensive Care Unit patients

Abstract

Background: Midline catheters (MCs) and peripherally inserted central venous catheters (PICCs) are placed by a specialist or trained nurse to avoid the complications of conventional central venous catheters (CCVCs). The safety of MC placements by residents has not been evaluated. We investigated the safety of ultrasound-guided MC placement by neurosurgery residents as a substitute for CCVC placement in patients in the neurosurgical intensive care unit (ICU) requiring intravenous (IV) therapy ≤14 days.Methods: Between July 2022 and June 2023, 57 MCs for 44 patients, 36 CCVCs for 35 patients, and 32 PICCs for 32 patients were placed during their ICU stay. One resident performed all MC placements under ultrasound guidance. The baseline and procedure-related parameters of the three catheter groups (MC, CCVC, and PICC) were analyzed, with focus on the comparison of complications between MC and CCVC.Results: The first-attempt success rate was significantly higher (p=0.003) in the MC group (96.5%) than in the CCVC group (80%). Insertional injuries occurred more frequently in the CCVC group than in the MC group (13.3% vs 0%, p=0.012). The rate of completion of therapy was significantly higher (p=0.002) in the MC group (86.0%) than in the CCVC group (53.3%). The incidence of bloodstream infections did not differ significantly between the MC and CCVC groups (p=0.605). Conclusion: MCs placed under ultrasound guidance by neurosurgery residents for neurosurgical ICU patients is safe and may be a substitute for CCVC indicated for IV therapy ≤14 days.