Midline catheter problems include home care case
Infection control consultants working with home care agencies should be aware of unexplained adverse events associated with midline catheters.
A recent report of four such incidents by the Centers for Disease Control and Prevention in Atlanta included the case of a pregnant woman undergoing home hydration therapy for management of hyperemesis gravidarum.1 A midline catheter was placed because of the long-term nature of the therapy and diminished peripheral access.
On flushing the catheter with saline, the patient complained of chest pain, shortness of breath, and a sense of "impending doom." Facial flushing and urticaria were noted on the upper chest. In response to the symptom onset, the catheter was immediately removed, and the symptoms resolved within minutes. The patient remained hemodynamically stable and was treated with diphenhydramine. Subsequently, she received hydration therapy without further complications.
Manufacturer studying the problem
A peripherally inserted catheter that may be used in patients requiring several weeks of intravenous therapy, midline catheters are unlike conventional short peripheral IV catheters in that they do not require changes every 48-72 hours. Since 1990, the Food and Drug Administration (FDA) has received reports of acute hypersensitivity-like reactions associated with insertion of midline catheters made from Aquavene (Landmark, Menlo Care, Menlo Park, CA), an elastomeric hydrogel material that becomes hydrated and expands after catheter insertion. To determine whether those reactions are associated with the midline catheter, the manufacturer is working with FDA on further studies, the CDC reports.
Possible sources for reactions include catheter components, intrinsic or extrinsic material on the inside or outside of the catheter, residual material associated with catheter sterilization or packaging, injectable fluids and medications, anatomic location of the catheter insertion, or insertion technique.
Reported reactions often have occurred during flushing, suggesting the cause of the reactions may be extrinsic to the catheter and is dislodged during flushing.
Infection control consultants and other health care workers who observe reactions associated with IV devices can report findings to the FDA Medwatch Program [telephone: (800) 322-1088] and through their state health department to the CDC Hospital Infections Program [telephone: (404) 639-6413].
Reference
1. Centers for Disease Control and Prevention. Adverse reactions associated with midline catheters -- United States, 1992-1995. MMWR 1996; 45:101-103. *
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