Tough Stick: Do Midline Catheters Reduce the Incidence of Deep Vein Thrombosis in Trauma Patients?

Introduction: Midline catheters are utilized for longer-term intravenous access in hospitalized patients, including the trauma population. While their implementation is presumed to reduce the risk of central line-associated bloodstream infections (CLABSIs), concerns regarding other serious complications, especially upper extremity deep vein thrombosis (UE-DVT), persist. This study aimed to compare the incidence of catheter-related complications including UE-DVT between trauma patients with midline catheters and those with central venous catheters (CVCs).


Methods: This retrospective cohort study included adult trauma patients (≥18 years old) hospitalized over a 20-year period. Patients were grouped based on the presence of traumatic injury and placement of either a midline catheter or CVC. Exclusion criteria included hospitalized patients without traumatic injury. The primary measured outcome was presence of UE-DVT within 30 days of line placement. Secondary outcomes included thrombophlebitis, cellulitis, and sepsis within 30 days of line placement. Statistical analysis included risk comparison, Kaplan–Meier survival analysis, hazard ratios, and event count comparisons.


Results: There was no significant difference in the risk of UE-DVT between patients with midlines and those with CVCs, with both groups demonstrating a 0.4% incidence (p = 0.891). Despite this, the incidence of phlebitis and thrombophlebitis although infrequent was significantly higher in the midline group compared to the CVC group (0.5% vs. 0.4%, p = 0.004). Cellulitis and acute lymphangitis occurred slightly more frequently in the midline group (4.1% vs. 3.8%, p = 0.059) and although the difference in proportions only approached significance, survival and hazard analyses confirmed a statistically significant difference. In contrast, sepsis was significantly lower in the midline group compared to the CVC group (4.3% vs. 5.4%, p < 0.001).


Conclusions: Midline catheter use in trauma patients was not associated with increased risk of UE-DVT compared to CVC use. However, midline use was associated with higher rates of phlebitis and cellulitis, though these complications were relatively rare. Notably, midline patients had a significantly lower incidence of sepsis, suggesting a potential benefit in infection risk reduction.