PICCs carry far fewer complications than midline catheters in outpatient antimicrobial therapy, US cohort finds

A single-centre US retrospective cohort study in Infection Control & Hospital Epidemiology followed 1,169 patients receiving outpatient parenteral antimicrobial therapy (OPAT) and found complications — bloodstream infection or venous thrombosis — occurred more often with midline catheters (6.4 per 1,000 line-days) than with peripherally inserted central catheters, or PICCs (1.1 per 1,000 line-days), an adjusted hazard ratio of 3.60 (95% confidence interval 1.66–7.81) [Primary Study].

This is a single-centre retrospective cohort, so the finding has not yet been replicated across other OPAT services or healthcare systems, and residual confounding by indication (why a particular device was chosen) cannot be fully excluded.

Vascular access device selection at the point of discharge is a decision made before a patient reaches community-based OPAT care, and this quantified complication difference is directly relevant to device-selection protocols wherever OPAT services choose between midlines and PICCs for anticipated therapy beyond a few days.