P1.011: Pediatric Midclavicular vs Peripherally Inserted Central Catheterization

Background: Peripherally inserted central catheters (PICC) provide long-term vascular access for adult and pediatric patients. Vascular access is "central" if the catheter tip is located in the superior (SVC) or inferior vena cava (IVC) just outside the right atrium. Relatively high central vein blood flow rates decrease complications from clot formation or vessel damage from caustic medications. “Midlines” are catheters with a tip positioned in a vein distal to the axillary-subclavian vein junction. In adults, midlines last longer than a peripheral intravascular catheter (PIV) but are associated with phlebitis and clot formation due to small vein size and low blood flow. Midlines in pediatric patients do not reliably last longer than a PIV. "Midclavicular catheters" (MC) are positioned with the tip in the subclavian vein when reaching the SVC proves difficult. Blood flow in the subclavian vein is about half of that in the SVC, but not as low as in the veins associated with a midline catheter.

Literature comparing complications of midline vs PICC lines often includes MC placement in the midline groups, so it is unknown if MC positioning is associated with more complications or less longevity. We hypothesized that MC lines are associated with more complications and incomplete therapy than PICC lines in a pediatric population.

Methods: Medical record review of 17 MC line and 37 age-matched PICC line patients identified at a Children's Hospital between 1/1/2023 and 12/31/2024.
Abstracted data: Age, weight, gender, use of alteplase/cysteine, congenital heart disease diagnosis, positive blood culture during line life, use of total parenteral nutrition (TPN), dates of line insertion and removal.
Statistical analysis included Fischer exact and Chi-square test for nominal data, Mann-Whitney U test for median data, and T-test for continuous data. P-value < 0.05 was considered statistically significant.

Results: Mean age and weight of the MC and PICC groups were similar (87.6 and 91.3 months, p = 0.57 and 27.5 and 28.2 kg, p=0.82). 17.6% of MC lines and 27% of PICC lines (p = 0.45) were associated with TPN use. In 65% of MC lines and 21% of PICC lines (p= 0.002) de-occlusion therapy was required. 71% of MC line patients had congenital heart disease compared to 37% of PICC line patients (p = 0.001). MC lines were used for a mean of 22.9 days and a median of 12 days (p=0.91). PICC lines were used for a mean of 25 days and a median of 11 days (p = 0.27).

Conclusion: In this small single-center sample, while MC lines are associated with more clotting complications, their use was not associated with incomplete intended therapy even with similar use of potentially venocaustic therapy (TPN) when compared to centrally placed PICC line. MC positioning in children may be equivalent to central positioning.