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Scientific publication: Evaluation of processes, outcomes and use of midline peripheral catheters for the purpose of blood collection1
October 12, 2021
Penoyer D, Bennett M, Patricia I, et.al CE Article: Evaluation of Processes, Outcomes, and Use of Midline Peripheral Catheters for the Purpose of Blood Collection. Journal of the Association for Vascular Access 1 December 2020; 25 (4): 8–17. doi: https://doi.org/10.2309/JAVA-D-20-00028
Midline catheters (MCs) are inserted in the peripheral veins of the upper extremity. Unlike Peripherally-Inserted Central Catheters (PICCs), MCs terminate in the peripheral and not the central vein.2
In patients with difficult venous access, MCs are a reliable option for drawing blood without the need for multiple venipunctures. 3 However, MCs are designed to administer medication. Little is known about how they perform when used to draw blood, and what the effects on the vasculature, catheter functions or patient outcomes may be.
The use of intravenous catheters to draw blood results in high rates of haemolysis, or the injury or breakdown of red blood cells.4 Haemolysed samples cannot be used for a variety of blood tests and in acute care settings, account for about 40%-70% of unsuitable specimens provided to the laboratory.5
Aims of the study
The primary purpose of this study was to analyse the processes, uses and outcomes of using MCs for blood collection. It aimed to
- Evaluate the rate of haemolysis when MCs are used for blood collection.
- Evaluate outcomes from using MCs for blood collection. These include catheter performance during blood sampling and dwell time.
- Evaluate the perceptions of nurses and the practices used for blood withdrawal.
Summary of the results
The study was prospective, observational and used mixed methods such as focus group sessions to evaluate nurses’ practices. 397 MCs used on 378 patients were studied over a period of 3 months.
The study analysed only one single type of MC, the BD PowerGlide Pro™ Midline Catheter, equipped with a reinforced tip.1 The haemolysis rate in the study was observed to be 0.69%, a figure much lower than the acceptable level of 2% defined by the American Society for Clinical Pathology.6
The dwell time of MCs used for blood draws (127.19 ± 109.13 hours) was longer than for the MCs that were not used for this purpose (88.34 ± 79.86 hours). According to the authors, this indicates that MC use for blood sampling does not impact dwell time or the ability to use them for therapeutic reasons. The authors attribute the increased dwell time to the fact that MCs used for blood drawing, in addition to therapeutic infusions, are subjected to more flushing, thereby maintaining their patency. The authors also claim that the use of MCs for blood drawing eliminates the need for additional venipuncture, improving patient comfort and reducing costs.
The main reason for catheter removal in this study was the completion of therapy. Hospital length of stays (LOS) for acute care are usually short (< 30 days) and the authors opine that this limited the understanding of catheter longevity over extended periods.
The authors claim that while the results were encouraging, more studies are needed to determine best practices for blood sampling through different types of MCs and outcomes.
#catheter dwell time #Haemolysis #Midline catheters
1 Penoyer D, Bennett M, Patricia I, et.al CE Article: Evaluation of Processes, Outcomes, and Use of Midline Peripheral Catheters for the Purpose of Blood Collection. Journal of the Association for Vascular Access 1 December 2020; 25 (4): 8–17. doi: https://doi.org/10.2309/JAVA-D-20-00028
2 Chopra V, Kaatz S, Swaminathan L, et al. Variation in use and outcomes related to midline catheters: results from a multicentre pilot study. BMJ Qual Saf. 2019;28(9):714– 720. doi:10.1136/bmjqs-2018-008554
3 Nancy Moureau, Gordon Sigl, Margaret Hill; How to Establish an Effective Midline Program: A Case Study of 2 Hospitals. Journal of the Association for Vascular Access 1 September 2015; 20 (3): 179–188. doi: https://doi.org/10.1016/j.java.2015.05.001
4Barnard EB, Potter DL, Ayling RM, Higginson I, Bailey AG, Smith JE. Factors affecting blood sample haemolysis: a cross-sectional study. Eur J Emerg Med. 2016 Apr;23(2):143-6. doi: 10.1097/MEJ.0000000000000195.
5 Green SF. The cost of poor blood specimen quality and errors in preanalytical processes. Clin Biochem. 2013; 46(13-14):1175–1179. doi:10.1016/j.clinbiochem.2013.06.001.
6 Lowe G, Stike R, Pollack M, et al. Nursing blood specimen collection techniques and hemolysis rates in an emergency department: analysis of venipuncture versus intravenous catheter collection techniques. J Emerg Nurs. 2008;34(1):26–32. doi:10.1016/j.jen.2007.02.006.
Approval number: BD-41013