Safety and Utilization of Midline Catheters in the Management of Acute Myeloid Leukemia: A Single Center Experience

BACKGROUND: Tunneled central venous catheters (TCVCs) are used in cancer patients for irritant or vesicant infusion such as chemotherapy or antibiotics. However, they can be associated which significant complications. Midline catheters (MCs) are peripheral intravenous access devices that ends in a large peripheral vein, easier to install and which may reduce the need for TCVCs. Therefore, the aim of this study is to assess the rate of adverse outcomes with both kind of catheter, in hospitalized patients for the treatment of acute myeloid leukemia.

METHODS: We retrospectively compared the use and outcomes of TCVCs and MCs at our institution between December 2017 and December 2018. Data were collected using electronic medical records. Both devices were used indistinctly among our hospitalized patients for chemotherapy, antibiotics and parenteral nutrition. The following complications were recorded: catheter related bloodstream infection (defined as documented bacteriemia and differential time to positivity pointing to TCVC as main source), local signs of infection (such as erythema or inflammation) at insertion site, thrombosis which required an anticoagulant treatment, extravasation and local bleeding at insertion site.

RESULTS: Through this period, 39 TCVCs and 50 MCs were used among 56 different patients. As expected duration of the device was shorter for MCs (mean 24days) as they were ablated on discharge, compared to TCVCs (mean 32.5 days). Median aplasia duration (defined as polymorphonuclear neutrofils count in peripheral blood <500/mm3) of each chemotherapic episode was 13 days [0 - 55 days] for patients harboring a TCVCs and 17 [0 - 46] for patients with MCs, with no statistically-significant difference. Main complications were infection related, TCVCs being more prone to have positive bloodstream cultures [20 (52.6%) vs 15 (29.4%), p= 0.027] and local signs of infection [7 (18.4%) vs 1 (2%); p=0.019] than MCs (and probably related to length of stay).

No extravasations were found in any group. As expected local bleeding was more frequent inTCVCs [6 (15.8%) vs 1 (2%); p=0.039].

Whole complications (infection, thrombosis and bleeding) were more frequent among TCVCs (n=35) than among MCs (n=18) even when reported to the length of the catheter (1.08 complications/day in TCVCs and 0.75 complications/day in MCs).

SUMMARY/CONCLUSION: MCs insertion -quick and easy- makes them user-friendly for hematologists and can be safely used among acute leukemia patients.