Minimizing Extravasation Rates of Midlines

Proper Insertion Techniques

Healthcare providers should use ultrasound guidance during midline insertion to visualize the vein and surrounding structures, which helps minimize damage to the vein wall and reduces the risk of extravasation 2
Selecting an upper extremity site for midline catheter insertion in adults is recommended, as lower extremity sites have higher complication rates 3, 4
Choosing a catheter with the smallest caliber compatible with the prescribed therapy can reduce vein trauma and thrombosis risk 2
Ensuring the catheter diameter is one-third or less of the vein diameter (as checked by ultrasound) can minimize the risk of mechanical irritation and subsequent extravasation 1
Using polyurethane or silicone catheters rather than Teflon cannulas is recommended, as they are less thrombogenic and cause less mechanical irritation to the vein wall 1

Positioning the catheter tip properly can prevent migration and dislocation, which can lead to extravasation 2
Avoiding the "pinch-off syndrome" can prevent catheter damage and extravasation by using proper insertion techniques 2
Securing the catheter adequately using transparent adhesive membranes and/or sutureless fixation devices can prevent movement that could lead to extravasation 1

Considering the osmolarity of the solution being infused through the midline is important, as high osmolarity solutions increase extravasation risk 1
Using lipid-based solutions when appropriate may have a protective effect on the vein wall 1
Maintaining the pH of infusates between 5 and 9 can minimize vein irritation and subsequent extravasation risk 1
Using infusion pumps with appropriate pressure settings can help detect early resistance that might indicate extravasation 1

Evaluating the catheter insertion site daily by palpation through the dressing can detect tenderness, and by visual inspection if a transparent dressing is used 3, 4
Removing the midline catheter immediately if the patient develops signs of phlebitis, infection, or a malfunctioning catheter is recommended 3

Designating trained personnel for the insertion and maintenance of midline catheters can reduce extravasation risk 6

Midlines have been associated with lower rates of phlebitis than short peripheral catheters and with lower rates of infection than central venous catheters (BSI rate of 0.8 per 1,000 catheter-days) 7
The median dwell time for midlines is approximately 6 days, though they can remain in place for up to 49 days when properly maintained 7