Midline Catheters See Rising Use, But New Studies Highlight Risks and Clinical Challenges
Midline catheters, once a niche option in vascular access, are increasingly being adopted in hospitals and outpatient settings worldwide. Designed to provide intermediate-term intravenous therapy—typically for 1 to 4 weeks—these catheters are inserted into a peripheral vein in the upper arm, with the tip stopping before entering central thoracic veins. Their use is growing amid a healthcare shift toward minimally invasive, patient-friendly, and home-based care options.
However, recent clinical studies and regulatory reviews in 2025 have raised new concerns about complications and the importance of appropriate patient selection.
What’s Fueling the Midline Surge?
The appeal of midline catheters stems from their ability to bridge the gap between short peripheral IVs and central lines like PICCs. With lower rates of central line-associated bloodstream infections (CLABSI) and deep vein thrombosis, they are increasingly viewed as a safer alternative for intermediate-duration infusion needs.
Midlines are now commonly used in oncology, long-term antibiotic therapy, hydration, and palliative care. Patients often prefer them due to greater comfort and fewer needle sticks, while hospitals benefit from reduced procedure costs and shorter inpatient stays.
According to market analysts, the global midline catheter market was valued at $1.26 billion in 2024 and is projected to reach $2.62 billion by 2034, driven by rising chronic disease burden, demand for outpatient services, and technological innovations in catheter design.
Recent Research Sparks Debate on Safety
In 2025, two major randomized trials challenged assumptions about the safety and performance of midline catheters compared to peripherally inserted central catheters (PICCs).
In one trial, patients receiving midlines experienced significantly higher rates of catheter dysfunction and complications than those with PICCs. Another study found a 30.4% complication rate for midlines—mostly involving occlusions or partial failures—compared to just 5.8% for PICCs.
Despite these findings, experts caution against generalizations. “While midlines may not be ideal in every case, they can be incredibly effective when used appropriately,” said Dr. Anita Sharma, a vascular access specialist based in Bengaluru. “The key is knowing when and how to use them.”
Oncology Use Showing Promise
Some of the most promising results for midline use have come from the oncology field. A recent Japanese study evaluated the use of midline catheters for continuous 5-fluorouracil (5-FU) infusion in head and neck cancer patients. The success rate for insertion was over 98%, with zero cases of phlebitis and a patient satisfaction rate above 90%. Only 6.8% of patients experienced mild complications, making the catheter a well-tolerated option for this specific setting.
“These results suggest that midlines can be both safe and effective in carefully selected chemotherapy patients,” said Dr. Kenta Ito, one of the study’s lead researchers.
Trouble in the OPAT Sector
On the flip side, a 2025 multicenter study on outpatient parenteral antimicrobial therapy (OPAT) raised red flags. Patients discharged with midlines to receive vancomycin infusions experienced significantly higher major complication rates—4.5% versus just 0.8% for other antibiotics. The study found an eightfold increase in bloodstream infections and a threefold rise in thrombosis risk when midlines were used for vancomycin.
The study’s authors recommend against using midlines for vancomycin in outpatient settings unless absolutely necessary. “These results underscore the importance of drug selection in determining catheter safety,” they said.
Neonatal and Pediatric Adaptations
Another recent innovation involves neonatal midline-like catheters, also called long peripheral catheters (LPCs). A 2024 study showed these devices offered longer dwell times and fewer complications than conventional neonatal peripheral IVs. As neonatal care evolves, experts anticipate wider adoption of LPCs as a midline-equivalent device for preterm and critically ill infants.
Balancing Risks and Benefits
While midline catheters offer several advantages—including fewer high-risk procedures, reduced infection rates, and better patient comfort—they are not without drawbacks.
Advantages:
Suitable for therapies lasting 1–4 weeks.
Avoid central line-associated complications.
Can be inserted bedside with ultrasound guidance.
Favorable patient comfort and satisfaction levels.
Disadvantages:
Higher risk of occlusion and device malfunction.
Limited compatibility with certain medications (e.g., vesicants, hyperosmolar solutions).
Increased risk of bloodstream infections with some drugs, like vancomycin.
Require trained staff for insertion and maintenance.
Clinical experts emphasize that midline catheter selection should be individualized, based on factors like therapy duration, drug characteristics, patient anatomy, and care setting.