Midline Catheter Use on the Rise Amid Push for Safer, Cost-Effective Vascular Access

Midline catheters, which are peripheral intravenous devices inserted into veins in the upper arm with tips residing below the axillary line and not in the central venous system, are typically used for treatments lasting from five days up to four weeks. They offer a reliable solution for administering medications, fluids, and even blood draws, making them an increasingly popular choice in emergency departments, oncology units, long-term care settings, and outpatient infusion centers.

The Safety Advantage

One of the most compelling reasons for the surge in midline catheter use is the significantly reduced risk of complications when compared to traditional CVCs. Central lines are associated with a higher risk of central line-associated bloodstream infections (CLABSIs), which contribute to prolonged hospital stays, increased morbidity, and higher healthcare costs.

According to a recent report from the Infection Control Society of India, midline catheters have shown a remarkably lower infection rate—estimated at fewer than 0.3 infections per 1,000 catheter days—compared to the average 2.5 per 1,000 for central lines. Unlike peripherally inserted central catheters (PICCs), midlines do not terminate in the superior vena cava, thereby avoiding the need for confirmatory chest X-rays or advanced imaging post-insertion.

Dr. Anjali Mehra, a vascular access specialist at a Mumbai-based tertiary care hospital, commented, “We’ve seen a noticeable reduction in bloodstream infections since increasing our use of midlines. The insertion is simpler, the patient comfort is higher, and the outcomes are overall much better in non-critical care cases.”

Cost and Workflow Efficiency

Midline catheters present a financially attractive option for healthcare systems striving to balance cost and care. The insertion of a midline catheter typically requires fewer resources than a CVC or PICC, with no need for an interventional radiologist, and can be performed at the bedside using ultrasound guidance. This reduces delays in therapy initiation and allows hospitals to improve patient throughput.

A 2024 study published in the Journal of Vascular Access Economics estimated that healthcare facilities could save over ₹25,000 per patient episode by switching from PICCs to midlines in appropriate cases. This includes savings on imaging, insertion labor, and infection-related complications.

In outpatient settings, particularly home infusion therapy, midline catheters are also providing new levels of independence to patients. With training and support, patients and caregivers are increasingly able to manage midlines at home, leading to reduced hospital visits and improved quality of life.

Clinical Indications Expanding

Initially reserved for limited indications such as short-term antibiotics, hydration, or analgesic infusions, the role of midline catheters is rapidly expanding. As more clinicians become familiar with their capabilities, midlines are being used for a broader range of medications—including some with pH levels previously thought unsuitable for peripheral veins.

Recent clinical protocols now support the use of midlines for medications with a pH between 5 and 9 and osmolality under 600 mOsm/L, opening up the potential for even more widespread application. Nevertheless, experts caution that patient selection, catheter material, and dwell time must be carefully considered to avoid phlebitis or thrombosis.

Training and Standardization Still Needed

Despite the advantages, a lack of standardized training and protocols across hospitals remains a hurdle. In many institutions, the decision to use a midline versus a PICC or peripheral IV still depends largely on the clinician’s discretion or institutional norms.

“There’s a pressing need to educate frontline providers about vascular access algorithms and to embed decision-support tools in electronic medical records,” said Rajeev Patel, a clinical educator in Pune. “When used appropriately, midlines can enhance care, but improper selection or maintenance can offset those benefits.”

To address this, several professional societies—including the Infusion Nurses Society and the Association for Vascular Access—have updated their guidelines in 2025 to include evidence-based recommendations on midline use. These cover everything from insertion techniques and antiseptic protocols to monitoring and removal criteria.