Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida.
Division of Critical Care Medicine, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York.
Ann Am Thorac Soc. 2023 Jul;20(7):1003-1011. doi: 10.1513/AnnalsATS.202209-814OC.
Little is known about the safety of infusing vasopressors through a midline catheter. To evaluate safety outcomes after vasopressor administration through a midline. We conducted a cohort study of adults admitted to 39 hospitals in Michigan (December 2017-March 2022) who received vasopressors while either a midline or peripherally inserted central catheter (PICC) was in place. Patients receiving vasopressors through a midline were compared with those receiving vasopressors through a PICC and, separately, to those with midlines in place but who received vasopressors through a different catheter. We used descriptive statistics to characterize and compare cohort characteristics. Multivariable mixed effects logistic regression models were fit to determine the association between vasopressor administration through a midline with outcomes, primarily catheter-related complications (bloodstream infection, superficial thrombophlebitis, exit site infection, or catheter occlusion). Our cohort included 287 patients with midlines through which vasopressors were administered, 1,660 with PICCs through which vasopressors were administered, and 884 patients with midlines who received vasopressors through a separate catheter. Age (median [interquartile range]: 68.7 [58.6-75.7], 66.6 [57.1-75.0], and 67.6 [58.7-75.8] yr) and gender (percentage female: 50.5%, 47.3%, and 43.8%) were similar in all groups. The frequency of catheter-related complications was lower in patients with midlines used for vasopressors than PICCs used for vasopressors (5.2% vs. 13.4%; < 0.001) but similar to midlines with vasopressor administration through a different device (5.2% vs. 6.3%; = 0.49). After adjustment, administration of vasopressors through a midline was not associated with catheter-related complications compared with PICCs with vasopressors (adjusted odds ratios [aOR], 0.65 [95% confidence interval, 0.31-1.33]; = 0.23) or midlines with vasopressors elsewhere (aOR, 0.85 [0.46-1.58]; = 0.59). Midlines used for vasopressors were associated with greater risk of systemic thromboembolism (vs. PICCs with vasopressors: aOR, 2.69 [1.31-5.49]; = 0.008; vs. midlines with vasopressors elsewhere: aOR, 2.42 [1.29-4.54]; = 0.008) but not thromboses restricted to the ipsilateral upper extremity (vs. PICCs with vasopressors: aOR, 2.35 [0.83-6.63]; = 0.10; model did not converge for vs. midlines with vasopressors elsewhere). We found no significant association of vasopressor administration through a midline with catheter-related complications. However, we identified increased odds of systemic (but not ipsilateral upper extremity) venous thromboembolism warranting further evaluation.
关于通过中线导管输注血管加压素的安全性知之甚少。为了评估通过中线输注血管加压素后的安全性结果。我们对密歇根州 39 家医院（2017 年 12 月至 2022 年 3 月）的成年患者进行了一项队列研究，这些患者在使用外周插入的中心导管（PICC）的同时接受了血管加压素，并且中线导管在位。将通过中线接受血管加压素的患者与通过 PICC 接受血管加压素的患者进行比较，并分别与中线在位但通过不同导管接受血管加压素的患者进行比较。我们使用描述性统计来描述和比较队列特征。使用多变量混合效应逻辑回归模型来确定通过中线给予血管加压素与结果之间的关联，主要是导管相关并发症（血流感染、浅表血栓性静脉炎、出口部位感染或导管阻塞）。我们的队列包括 287 名中线导管接受血管加压素的患者、1660 名 PICC 导管接受血管加压素的患者和 884 名中线导管接受其他导管接受血管加压素的患者。年龄（中位数[四分位距]：68.7[58.6-75.7]、66.6[57.1-75.0]和 67.6[58.7-75.8]yr）和性别（女性百分比：50.5%、47.3%和 43.8%）在所有组中相似。中线导管用于血管加压素的患者与用于血管加压素的 PICC 导管（5.2%对 13.4%；<0.001）的导管相关并发症发生率较低，但与通过不同设备给予血管加压素的中线导管（5.2%对 6.3%；=0.49）相似。调整后，与 PICC 导管（调整后的优势比[aOR]，0.65[95%置信区间，0.31-1.33]；=0.23）或中线导管（aOR，0.85[0.46-1.58]；=0.59）给予血管加压素相比，通过中线给予血管加压素与导管相关并发症无关。与 PICC 导管（aOR，2.69[1.31-5.49]；=0.008）相比，用于血管加压素的中线导管与全身性血栓栓塞（与用于血管加压素的 PICC 导管相比）的风险增加有关，但与同侧上肢的血栓形成无关（与用于血管加压素的 PICC 导管相比，aOR，2.42[1.29-4.54]；=0.008）。与用于血管加压素的中线导管相比，没有发现与同侧上肢静脉血栓形成相关的显著相关性（与用于血管加压素的 PICC 导管相比，aOR，2.35[0.83-6.63]；=0.10；模型未收敛）。我们没有发现通过中线给予血管加压素与导管相关并发症之间存在显著关联。然而，我们发现全身性（但不是同侧上肢）静脉血栓栓塞的可能性增加，需要进一步评估。
