Background: Intravascular catheters are indispensable to contemporary inpatient therapy and peripherally inserted central catheters (PICCs) and midline catheters (MCs) are routinely used for intermediate to long-term therapy. In spite of their usefulness, there are still issues about infection, thrombosis, and mechanical complications.

Objectives: We conducted this systematic review and meta-analysis to compare CRBSIs, thromboembolism, and general complication incidence between Peripheral inserted central catheters and midline catheters, to help guide device choice based on available evidence.

Methods: According to PRISMA guidelines, we systematically searched PubMed, Embase, Scopus, and Cochrane databases were searched. Nine trials (RCTs and observational) enrolling 4,200+ patients were included. Relative risks and their 95% confidence intervals were calculated for the primary and secondary outcomes.

Results: A meta-analysis of nine trials, which included over 4,200 patients, was conducted to compare the outcomes of midline catheters (MCs) versus peripherally inserted central catheters (PICCs). The results showed that MCs were associated with a non-significant 52% reduced risk of catheter-related bloodstream infections (CRBSIs) compared to PICCs (RR 0.48, 95% CI: 0.20-1.14). The study found no significant difference in the incidence of thromboembolism between the two types of catheters (RR 1.24, 95% CI: 0.29-5.28). However, MCs were found to have a significantly higher overall complication rate (RR 1.51, 95% CI: 1.06-2.17). While the rates of phlebitis and occlusion were lower with MCs, this difference was not statistically significant.

Conclusion: Compared to earlier meta-analyses with limited outcomes or fewer studies, our review offers a more comprehensive assessment of midline catheter use by examining CRBSI, phlebitis, thromboembolism, and occlusion. We included RCTs and observational studies, enhancing real-world relevance, and found overall low risk of bias in RCTs. By incorporating diverse patient populations and care settings, our findings provide practical guidance for clinicians managing patients with difficult vascular access or high complication risk.

While midlines may lower the risk of bloodstream infections and phlebitis, they carry a higher overall complication rate. Clinical decisions should be individualized, and further large trials are needed.

Keywords: PICC, midline catheter, CRBSI, thrombosis, meta-analysis.

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2025
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