Comparing Midline and PICC Lines in Children: Is a Large-Scale Trial Feasible?
 "Comparing Midline and PICC Lines in Children: Is a Large-Scale Trial Feasible?")
Midline catheters are gaining interest as a safer alternative to peripherally inserted central catheters (PICCs) in pediatric patients who require medium-term intravenous therapy. However, robust evidence comparing the two devices in children is still limited. A recent randomized feasibility trial explored whether a full-scale study comparing midline catheters and PICCs in hospitalized children is possible—and what early outcomes tell us.
Study Overview
This single-site study enrolled children aged 2-17 years requiring noncentral vascular access for 5-14 days. Two groups were evaluated:
A randomized controlled trial (RCT) arm (goal: 30 patients per group)
An observational arm for patients who declined randomization
Between August 2022 and August 2023, only 43 of 260 screened patients were eligible, largely due to a shift away from PICC use for this indication. A total of 35 patients were enrolled: 8 in the RCT and 27 in the observational arm.
Key Findings
- RCT feasibility was limited due to low PICC use and recruitment numbers.
- Despite low enrollment, study acceptability was high among clinicians (96%) and patients (100% adherence to assigned devices).
- Preliminary outcome data (e.g., dwell time, failure rates) were collected but not powered for effectiveness comparisons.
Conclusion
This trial highlighted the logistical challenges of comparing midline and PICC devices in pediatric care, especially as clinical practice shifts away from PICCs. While the RCT was not feasible, future research may benefit from a hybrid effectiveness-implementation study focused on vascular access decision-making algorithms.
Authors: Alina G. Burek, Kelsey Porada, Matthew R. Plunk, Sarah Corey Bauer, Melodee Liegl, Amy Pan, Kathryn E. Flynn, David C. Brousseau, Reiner Gedeit, Amanda J. Ullman
