The Middle Ground: A Survey of Fellowship Training Practices With Midline Catheters in Critical Care

Sunday, March 22, 2026

12:15 PM - 1:15 PM Central Time

Location: Connections Central - RST 15

DK

Daniel King, MD

George Washington University Hospital

Disclosure(s): No relevant financial relationship(s) to disclose.
DY

David Yamane, MD

Associate Professor
George Washington University

Disclosure information not submitted.
GP

Gina Patel, MD

Critical Care Fellow
George Washington University Hospital

Disclosure information not submitted.
SS

Stephanie Streit, MD

Assistant Professor
George Washington University Hospital

Disclosure information not submitted.
BS

Brendan Sweeney, N/A

Medical Student
George Washington University Hospital

Disclosure information not submitted.
ES

Eduard R. Shaykhinurov, N/A

District of Columbia

Disclosure(s): No relevant financial relationship(s) to disclose.
HS

Huma Saleem, n/a

Study Coordinator
Department of Anesthesiology and Critical Care Medicine, The George Washington Medical Faculty Associates

Disclosure information not submitted.
Danielle Davison, MD (she/her/hers)

George Washington University Hospital, District of Columbia

Disclosure information not submitted.
KH

Katrina Hawkins, MD

Physician, Critical Care
George Washington University Hospital

Disclosure information not submitted.

Introduction: Midline catheters (MC) are 10-20 cm intravenous lines (IV) inserted in the peripheral veins of the upper arm and utilized for patients who require longer term IV access. This makes them advantageous in the intensive care unit (ICU). Guidelines on medication infusion through MC are limited and clinical practice varies. It is unclear how MC practice variation affects critical care fellowship experience. We sought to investigate the relationship between institutional practices surrounding MC and the role of trainees.

Methods: A survey was sent to all Critical Care Fellowship program directors investigating their use of MC. Program type, number of hospital beds and trainees were collected. The use of vasopressors (VP), hypertonic saline (HS), and parenteral nutrition (PN) through MC was assessed, as was the type of providers placing MC (interventional radiology (IR), fellows, residents, or advanced practice providers). Statistical analysis was performed using IBM SPSS statistics. Associations between clinical variables were assessed using Fischer’s exact test.

Results: MC use was reported in 75.5% of ICUs, with 70 of 230 program directors responding. There was no difference in the use of VP, HS, or PN across institution types, bed capacities, or number of trainees. Larger hospitals (>500 beds) are significantly more likely to have IR place MC compared to smaller hospitals (88.9% vs 58.8%, p=0.025). Smaller hospitals (100-499 beds) are significantly more likely to have residents place MC (17.6% vs 2.8%, p=0.032). VP use was reported in 66% of those who used MC with 60% having no duration limit. Programs with fellow placed MC are significantly more likely to use VP through MC compared to programs without fellow placed MC (93.3% vs 55.3%, p= 0.026). HS use was reported in 62.3% of MC use with 45.5% having no duration limit. PN use was reported in 20.8% of MC use with 18.2% indicating total PN was allowed. Programs that utilize fellows for midline placement are significantly more likely to administer PN through midlines (33.3% vs 15.8%, p=0.030).

Conclusions: Though MC use in critical care training ICUs in the US is prevalent, hospital specific factors appear to influence who is placing the MC and how MCs are utilized.