Making Midlines the “Default When Appropriate” in PICU: What Worked 

Study Overview

In paediatric intensive care, central venous catheters can be overused—sometimes when a midline catheter could do the job with less risk. This mixed-method implementation study tested a tailored, implementation-science approach to increase appropriate midline use in a 75-bed paediatric ICU.

The project ran in three phases:

1. Pre-implementation: July-August 2023
2. Implementation: September 2023
3. Post-implementation: October-November 2023

Focus groups were used to map barriers and enablers, then a suite of targeted strategies was introduced. The team measured:

• Clinician perceptions (acceptability, feasibility, appropriateness) using a 36-item survey
• Midline utilisation rates
• Balancing outcomes (vascular access harm and midline failure)

Key Findings

- Clinician confidence improved
Survey scores improved across all 36 perception items, with statistically significant gains in parts of the feasibility domain.

- Midline use increased during rollout, then dipped
Midline utilisation rose from 3% pre-implementation to 7.2% during implementation, then settled to 4.3% post-implementation—suggesting momentum was strongest while strategies were “live.”

- No increase in vascular access harm
Increasing midline use did not lead to higher overall vascular access harm.

- Midline failure rates improved
Midline failure dropped substantially, from 57.1% pre-implementation to 14.3% post-implementation.

Implications

This study shows a practical truth about change in PICU: it’s not enough to introduce a device—you need to change how teams think, decide, and sustain practice. Tailored, theory-informed strategies improved perceptions and supported safer midline use without increasing harm. But the drop after implementation highlights the hard part: keeping the change going.

For other services, the biggest transferable lesson is the framework: use barrier mapping + tailored strategies, track both uptake and safety, and plan for sustainability early (ongoing champions, prompts in workflow, audit/feedback, and refreshers) so midlines don’t become a “project month” and then fade.

Read More:https://www.australiancriticalcare.com/article/S1036-7314(25)00344-3/abstract 

Authors: Mark D. Weber; Warren Frankenberger; Amanda J. Ullman; Bingqing Zhang; Danielle Traynor; Taylor Slocumb; Kim Perry; Eileen Nelson; Amanda Watson; Thomas W. Conlon; Amanda Bettencourt.