The effectiveness of applying different tip positions of midline catheters：a Meta-analysis

doi:10.3761/j.issn.0254-1769.2025.08.016

Abstract

Abstract:

Objective To evaluate the effectiveness of different tip positions applied to midline catheters（MC） and provide evidence-based evidence for venous catheter tip positioning in clinical practice. Methods Computerized searches of PubMed，Web of Science，Embase，Cochrane Library，CINAHL，CNKI，Wanfang Database，VIP，and CBM for studies on the effectiveness of applying MC with different tip positions were performed from the time of database construction to July 2024. Meta-analysis was performed using Rev Man 5.3 software after 2 investigators independently screened the studies，extracted the information and evaluated the quality of the included studies. Results A total of 9 studies with 2 302 hospitalized patients were included. The quality evaluation results of the included studies are all B-level. Meta-analysis showed that when the tip of the MC was located in the subclavian vein compared with the tip of the MC in the axillary vein，the rate of total catheter-related complications，phlebitis，blood leakage，infiltration，catheter occlusion，catheter dislocation，and catheter-associated thrombosis were lower，with a statistically significant difference（P<0.05）. When the tip of the MC was located in the subclavian vein compared with the tip of the MC in the axillary vein，the catheter retention time was longer，with a statistically significant difference（P=0.007）. The descriptive analysis showed a lower rate of extubation due to complications when the tip of the MC was located in the subclavian vein compared with when the tip was located in the axillary vein（P<0.05）. Conclusion When the tip of the MC is located in the subclavian vein compared to when it is located in the axillary vein，the incidence of total catheter-related complications，phlebitis，blood leakage，infiltration，catheter occlusion，catheter dislocation，catheter-associated thrombosis，and the rate of catheter extractions due to complications were lower，and the catheter was left in place for a longer period of time. Due to the limitations of the quantity and quality of the included studies，more large-sample，high-quality studies are needed to further validate the effectiveness of different tip positions of MC.

Key words: Midline Catheter, Catheter Tip, Complications, Meta-Analysis, Evidence-Based Nursing

摘要：

目的评价中等长度静脉导管不同尖端位置的应用效果，为导管尖端定位提供循证依据。方法计算机检索PubMed、Web of Science、Embase、Cochrane Library、CINAHL、中国知网、万方数据库、维普数据库和中国生物医学文献数据库中有关中等长度静脉导管不同尖端位置应用效果的研究，检索时限均为建库至2024年7月。由2名研究者独立筛选文献、提取资料并评价文献质量，采用RevMan 5.3软件进行Meta分析。结果纳入9篇文献，共2 302例住院患者。纳入文献质量均为B级。Meta分析结果：与腋静脉相比，中等长度静脉导管尖端位于锁骨下静脉时，导管相关总并发症发生率、静脉炎、渗血、渗液、导管堵塞、导管脱出及导管相关性血栓发生率均较低，差异具有统计学意义（P<0.05）；中等长度静脉导管尖端位于锁骨下静脉时导管留置时间长于腋静脉，差异具有统计学意义（P=0.007）。描述性分析结果：与腋静脉相比，中等长度静脉导管尖端位于锁骨下静脉时因并发症拔管率较低（P<0.05）。结论与腋静脉相比，中等长度静脉导管尖端位于锁骨下静脉时，导管相关并发症发生率、因并发症拔管率较低，导管留置时间较长。未来仍需大样本、高质量的研究进一步验证中等长度静脉导管不同尖端位置的应用效果。

关键词: 中等长度静脉导管, 导管尖端, 并发症, Meta分析, 循证护理学

SHENG Wanting, WANG Rui, ZHAO Yuxiao, QI Pengfei, GAO Silong, FENG Juan, LÜ Bohan, NIU Qun, WANG Gang. The effectiveness of applying different tip positions of midline catheters：a Meta-analysis[J]. Chinese Journal of Nursing, 2025, 60(8): 990-997.

盛婉婷, 王蕊, 赵玉晓, 戚鹏菲, 高祀龙, 冯娟, 吕伯瀚, 牛群, 王刚. 中等长度静脉导管不同尖端位置应用效果的Meta分析[J]. 中华护理杂志, 2025, 60(8): 990-997.

Figures/Tables 5

Table 1 Search strategies of studies

Figure 1 Flow diagram of study screening

Table 2 Basic characteristics of included studies（n=9）

Table 3 Quality evaluation results included NRS（n=7）

Table 4 Summary of Meta-analysis results on the incidence of MC related complications

References 29

[1]	Nickel B, Gorski L, Kleidon T, et al. Infusion therapy standards of practice,9th edition[J]. J Infus Nurs, 2024, 47(Suppl 1):S1-S285.
[2]	Pittiruti M, Van Boxtel T, Scoppettuolo G, et al. European reco-mmendations on the proper indication and use of peripheral venous access devices(the ERPIUP consensus):a WoCoVA pro-ject[J]. J Vasc Access, 2023, 24(1):165-182.
[3]	Villalba-Nicolau M, Chover-Sierra E, Saus-Ortega C, et al. Use-fulness of midline catheters versus peripheral venous catheters in an inpatient unit:a pilot randomized clinical trial[J]. Nurs Rep, 2022, 12(4):814-823.
[4]	Kleidon TM, Gibson V, Cattanach P, et al. Midline compared with peripheral intravenous catheters for therapy of 4 days or longer in pediatric patients:a randomized clinical trial[J]. JAMA Pediatr, 2023, 177(11):1132-1140. DOI PMID
[5]	Bing SX, Smotherman C, Rodriguez RG, et al. PICC versus mid-lines:comparison of peripherally inserted central catheters and midline catheters with respect to incidence of thromboem-bolic and infectious complications[J]. Am J Surg, 2022, 223(5):983-987.
[6]	Swaminathan L, Flanders S, Horowitz J, et al. Safety and out-comes of midline catheters vs peripherally inserted central catheters for patients with short-term indications:a multicenter study[J]. JAMA Intern Med, 2022, 182(1):50-58.
[7]	Fabiani A, Santoro M, Sanson G. The catheter-to-vein ratio at the tip level,not the catheter type,as a risk factor for a catheter failure. A retrospective comparative study of polyurethane mid line and long peripheral catheters[J]. Heart Lung, 2023,60:39-44.
[8]	中国研究型医院学会护理分会项目组. 中等长度静脉导管临床应用专家共识[J]. 中华护理杂志, 2020, 55(增刊):43-50.
	The Project Team of the Nursing Branch of the Chinese Re-search Hospital Association. Expert consensus on the clinical app-lication of midline catheters[J]. Chin J Nurs, 2020, 55(Suppl):43-50.
[9]	Zhao LF, Fan XP, Zhao L, et al. Midline catheter tip position and catheter-related complications in antimicrobial therapy:a multi-center randomized controlled trial[J]. Int J Nurs Stud, 2023,141:104476.
[10]	Elli S, Pittiruti M, Pigozzo V, et al. Ultrasound-guided tip loca-tion of midline catheters[J]. J Vasc Access, 2020, 21(5):764-768.
[11]	吴惠文, 丘宇茹, 陈良英. 中等长度导管尖端位置与并发症的关系[J]. 岭南急诊医学杂志, 2020, 25(5):550-551.
	Wu HW, Qiu YR, Chen LY. Relationship between tip position of medium-length catheter and complications[J]. Lingnan J Emerg Med, 2020, 25(5):550-551.
[12]	Higgins JPT, Thomas J, Chandler J, et al. Cochrane handbook for systematic reviews of interventions[M]. 2nd ed. Chichester (UK): John Wiley & Sons, 2019.
[13]	Sterne JAC, Savovic J, Page MJ, et al. RoB 2:a revised tool for assessing risk of bias in randomised trials[J]. BMJ, 2019, 366:l4898.
[14]	Sterne JA, Hernán MA, Reeves BC, et al. ROBINS-I:a tool for assessing risk of bias in non-randomised studies of interven-tions[J]. BMJ, 2016,355:i4919.
[15]	刘海宁, 吴昊, 姚灿, 等. Meta分析中连续性数据的深度提取方法[J]. 中国循证医学杂志, 2017, 17(1):117-121.
	Liu HN, Wu H, Yao C, et al. Advanced methods of data ex-traction for continuous outcomes in meta-analysis[J]. Chin J Evid Based Med, 2017, 17(1):117-121.
[16]	赵林芳, 蔡志云, 樊小朋, 等. 中等长度静脉导管置管不同尖端位置的效果比较[J]. 中华护理杂志, 2022, 57(5):517-524. DOI URL
	Zhao LF, Cai ZY, Fan XP, et al. Application comparison of different tip positions of midline catheters[J]. Chin J Nurs, 2022, 57(5):517-524. DOI URL
[17]	Fu J, Zhao LL, Tian YM, et al. Impact of terminal tip location of midline catheters on catheter-related complications and indwelling duration in elderly patients[J]. Nurs Open, 2023, 10(4):2349-2356.
[18]	毛迎. 中长导管尖端位置位于腋前线和锁骨中线的安全性比较[J]. 微创医学, 2023, 18(1):73-76.
	Mao Y. Safety comparison of the tip position of medium-long catheter in axillary front line and clavicle midline[J]. Prev Med Tribune, 2023, 18(1):73-76.
[19]	柏健, 郭妍, 莫永珍, 等. 中等长度导管不同尖端位置对老年病人的影响[J]. 实用老年医学, 2022, 36(12):1300-1303.
	Bai J, Guo Y, Mo YZ, et al. Effects of different tip positions of midline catheter in elderly patients[J]. Pract Geriatr, 2022, 36(12):1300-1303.
[20]	古华新, 李桂先, 方文华, 等. 超声引导下中长导管在静脉输液治疗中导管尖端位置、留置时间与并发症发生的相关性分析[J]. 当代护士(上旬刊), 2020, 27(8):144-146.
	Gu HX, Li GX, Fang WH, et al. Correlation analysis of ca-theter tip position,indwelling time and complications in intravenous infusion under ultrasound guidance[J]. Mod Nurse, 2020, 27(8):144-146.
[21]	柏健, 郭妍. 中长导管尖端位置位于腋前线和锁骨中线的比较[J]. 全科口腔医学杂志(电子版), 2019, 6(34):133,137.
	Bai J, Guo Y. Comparison of the position of the tip of the medium-long catheter between the axillary front line and the clavicle center line[J]. Electron J Gen Stomatol, 2019, 6(34):133,137.
[22]	Adams DZ, Little A, Vinsant C, et al. The midline catheter:a clinical review[J]. J Emerg Med, 2016, 51(3):252-258.
[23]	Ng M, Mark LKF, Fatimah L. Management of difficult intrave-nous access:a qualitative review[J]. World J Emerg Med, 2022, 13(6):467-478.
[24]	Passaro G, Pittiruti M, la Greca A. The fibroblastic sleeve,the neglected complication of venous access devices:a narrative review[J]. J Vasc Access, 2021, 22(5):801-813.
[25]	杨小惠, 刘畅, 于卫华, 等. 不同长度外周静脉导管在减重手术患者围手术期的应用效果评价[J]. 中华护理杂志, 2024, 59(4):401-407. DOI URL
	Yang XH, Liu C, Yu WH, et al. Study on the application of different-length peripheral intravenous catheters in patients undergoing metabolic and bariatric surgery:a randomized clinical trial[J]. Chin J Nurs, 2024, 59(4):401-407.
[26]	国际血管联盟中国分会, 中国老年医学学会周围血管疾病管理分会. 输液导管相关静脉血栓形成防治中国专家共识(2020版)[J]. 中国实用外科杂志, 2020, 40(4):377-383.
	International Union of Angiology(China Branch),Peripheral Vascular Disease Management Branch of Chinese Geriatrics Society. Chinese expert consensus on prevention and treatment catheter related venous thrombosis(2020 edition)[J]. Chin J Prac Surg, 2020, 40(4):377-383.
[27]	贺文静, 王丹丹, 王文, 等. 中长导管与PICC导管相关性静脉血栓发生率比较的Meta分析[J]. 中华护理杂志, 2024, 59(4):416-424. DOI URL
	He WJ, Wang DD, Wang W, et al. Common incidence of ca-theter-related venous thrombosis between midline catheter and peripherally inserted central catheter:a Meta-analysis[J]. Chin J Nurs, 2024, 59(4):416-424.
[28]	Tripathi S, Kumar S, Kaushik S. The practice and complica- tions of midline catheters:a systematic review[J]. Crit Care Med, 2021, 49(2):e140-e150.
[29]	Thiyagarajan S, Ravindran C. Conventional central venous cathe-ters as tunnelled mid-clavicular midline catheters:description of novel application and outcome analysis[J]. J Vasc Access, 2022, 23(1):98-104.