Safety and Efficacy of Midline and PICC

Study Overview
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Brief Summary
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The purpose of this study is to assess the non-inferiority for safety and efficacy of using Midline in comparison with PICC for intravenous therapy that do not require a central catheter.

Detailed Description
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Vascular access devices (VADs), including peripherally inserted central venous catheters (PICCs) remain a cornerstone for the delivery of necessary intravenous therapy. PICCs are being selected for venous access more frequently today than ever before. The advantage of PICC is that it can be used for all intravenous therapy. However, PICC requires the use of fluoroscopy or other type of guidance which add to the cost and time required to insert the catheter. Midline, on the other hand, can be inserted under ultrasound guidance, takes less time to be inserted and cost less than PICC insertion. Despite lower cost and better accessibility of midline in comparison with PICC for non-vesicant intravenous therapy, there is very little evidence in the literature to suggest that one type of venous access is better than the other. The primary objective of this study is to assess the non-inferiority for safety and efficacy of using Midline in comparison with PICC for intravenous therapy that do not require a central catheter. Results of this trial will allow improving a quality of evidence for using midline instead of PICC for specified indications. If Midline are non-inferior for some indications, they would represent a more accessible and less expensive alternative than PICC insertion.

Official Title
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Safety and Efficacy of Midline and Peripherally Inserted Central Catheter for Intravenous Therapy: a Randomized Controlled Trial

Conditions
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Vascular Access Devices, Central Venous Catheter

Intervention / Treatment
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* Device: Bard PowerPICC
* Device: Bard PowerMidline catheter


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Required intra venous therapy Expected duration of the venous access: > 6 days and < 30days Exclusion Criteria: Patient has a contraindication to insertion of either a Midline or a PICC relative to the therapy Patient from other hospitals who come to the CHUM only for the installation of a central line Decreased cognitive ability to care for device at home Preexisting bacteremia (ie, existing positive blood cultures that had not been repeated with negative results) Preexisting venous thrombosis or known hypercoagulable states (such as protein C or S deficiency, antithrombin deficiency, lupus anticoagulant) Venous access with multiple lumens required Patients not able to give informed consent Prior participation to this study Patient is enrolled in another investigational study Patients hospitalized in the intensive care unit Patients who are difficult to puncture and require multiple blood samples

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Peripherally inserted central venous catheters<br>Bard PowerPICC | Device: Bard PowerPICC<br>* PICC Insertion<br>|
| Active Comparator: Midline<br>Bard PowerMidline catheter | Device: Bard PowerMidline catheter<br>* Midline Insertion<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| % of patients without VAD-related adverse event requiring medical intervention | Infections, Thrombophlebitis, Infiltration, Bleeding, Pain, Death | Until 1 week after VAD retrieval | 
| % of patients whose intended or additional I.V treatments could be completed with the VAD without VAD complications, dysfunctions or limitations (ex: need for central access or for additional peripheral or central lumens/catheters) |  | Until 1 week after VAD retrieval | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| % of patients who experience VAD-related adverse events requiring medical intervention | Infections, Thrombophlebitis, Infiltration, Bleeding, Pain, Death | Until 1 week after VAD retrieval | 
| Number of VAD-related adverse events requiring medical intervention per 1000 catheter/days |  | Until 1 week after VAD retrieval | 
| Time to first VAD-related adverse events |  | Until 1 week after VAD retrieval | 
| Duration VAD intervention (Midline or PICC) |  | Index procedure | 
| Number of additional interventions to insert the VAD |  | Index procedure | 
| % of patients who required another VAD to complete the intended or additional iv treatments, either because of VAD complications, dysfunctions or limitations |  | Until 1 week after VAD retrieval | 
| % of patient without failed blood sampling attempts through the VAD |  | Until 1 week after VAD retrieval | 
| % of patients for whom the end of treatment was the reason for VAD retrieval |  | Until 1 week after VAD retrieval | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Peripherally Inserted Central Catheter Line Insertion, Catheterization, Peripheral Venous