Midline vs Peripheral IV Catheters for Difficult Intravenous Access

Overseen By Michael J Waxman, MD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Albany Medical College

Disqualifiers: Under 18, Prisoners, Non-English, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 1

Duration: Up to 28 days

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial compares two types of intravenous (IV) catheters used in emergency departments for patients with difficult-to-access veins. It examines whether a 4-inch single lumen midline catheter or a 2-inch long peripheral IV catheter more effectively delivers medication and draws blood. Suitable participants have experienced at least two unsuccessful IV attempts or have a history of requiring special techniques, such as ultrasound guidance, for IV access. This includes individuals with conditions like sickle cell disease or end-stage renal disease that complicate IV access. As an unphased trial, this study allows patients to contribute to research that may enhance IV access techniques for those with challenging conditions.

Do I need to stop my current medications for this trial?

The trial information does not specify whether you need to stop taking your current medications. It seems focused on testing different types of IV catheters, so it's unlikely that your medications would be affected, but you should confirm with the study team.

What prior data suggests that these catheter techniques are safe for patients with difficult IV access?

Research has shown that both long peripheral IV catheters and single lumen midline catheters are generally safe. The long peripheral IV catheter effectively accesses veins, but it can sometimes fail. One study found that about 36% of these catheters failed, often due to blockages or fluid leaks, which occurred in about 23% of cases.

Midline catheters, by contrast, are also considered safe and may have a lower risk of failure compared to long peripheral catheters. Research indicates that midline catheters have an 85% lower risk of failure compared to other longer catheters. They perform well for short-term use and have fewer major complications.

Both types of catheters have FDA approval, indicating they have been tested and deemed safe for certain uses. While no medical device is completely without risk, current evidence suggests that these catheters are generally well-tolerated. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about this trial comparing midline and peripheral IV catheters for patients with difficult intravenous access because they hope to find out which method is more effective and safer. The single lumen midline catheter is unique as it features an accelerated Seldinger technique with a built-in internal wire system, eliminating the need for premeasurement or a confirmatory chest X-ray. This could make the process faster and more convenient compared to traditional peripheral IV catheters, which often require more complex preparation. By comparing these two methods, the trial aims to determine the optimal approach for patients who typically face challenges with standard IV access.

What evidence suggests that this trial's catheters could be effective for difficult IV access?

This trial will compare the effectiveness of midline catheters and long peripheral IV catheters for patients with difficult intravenous access. Research has shown that midline catheters, which participants in one arm of this trial will receive, might work better for patients who have trouble with regular IVs. Studies indicate that midline catheters have fewer complications than long peripheral IV catheters, which are being tested in another arm of this trial. Specifically, the chance of catheter failure is 85% lower with midline catheters. In contrast, long peripheral IV catheters often experience issues like blockages or leaks into nearby tissue, occurring in up to 36% of cases. Additionally, midline catheters have been successfully used for treatments like IV antibiotics and in patients with difficult vein access, demonstrating their effectiveness in these situations. ^{2 4 6 7 8}

Are You a Good Fit for This Trial?

This trial is for patients in the emergency department who have veins that are hard to access for IV insertion. It's not specified who can't join, but typically those with certain health conditions or previous complications related to IV access might be excluded.

Inclusion Criteria

Self-reported history of difficult IV access and history of requiring 2 or more IV attempts on a previous visit

Prior or current implanted port device

History of or active intravenous drug use

Exclusion Criteria

Known Prisoners

Non-English-speaking patients

Patients without identifiable target veins by ultrasonography

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

1-2 weeks

Treatment

Participants receive either a long peripheral intravenous catheter or a single lumen midline catheter, with procedures performed in the emergency department.

Up to 28 days

1 visit (in-person)

Follow-up

Participants are monitored for catheter survival, complications, and patient satisfaction.

1 month

What Are the Treatments Tested in This Trial?

Interventions

• Long Peripheral Intravenous Catheter
• Single Lumen Midline Catheter

Trial Overview The study compares two types of catheters: a 10-cm single lumen midline and a standard 4.78 cm long peripheral intravenous catheter, to see which is better for administering medication in patients with difficult IV access.

How Is the Trial Designed?

Group I: 10 cm Single Lumen Midline Catheter Experimental Treatment 1 Intervention

The BD Powerglide Pro Midline catheter is currently approved for use by the FDA and by Albany Medical Center. This 18-gauge or 20-guage MC is distinct in that it is a standard 10-cm, does not require premeasurement or trimming of the catheter prior to placement, and features an accelerated Seldinger technique, meaning that it has a built-in deployable internal wire system. Additionally, because it is only 10-cm, it does not require a confirmatory chest x-ray prior to use. The provider will use standard aseptic technique for placing the MC (e.g., chlorhexidine prep, sterile probe cover and gel). Once the target vessel is identified, an ultrasound image of the vessel will be captured and recorded with the subject's study ID number from the randomization packet to allow for vessel depth and size measurement.

Group II: 4.78 cm Long Peripheral Intravenous Catheter Active Control 1 Intervention

The BD Insyte Autoguard 4.78 cm 18- or 20-gauge needle with self-retraction is currently approved for use by the FDA and by Albany Medical center. The long PIV will be placed using standard aseptic technique (e.g., chlorhexidine prep, sterile gloves, sterile ultrasound probe cover and gel). Once the target vessel is identified, an ultrasound image of the vessel will be captured and recorded with the subject's study ID number in the comments section of the QPATH worksheet to allow for vessel depth and size measurement. Operators will be instructed to use standard techniques in US-guided vascular access.

Who Is Running the Clinical Trial?

Albany Medical College

Lead Sponsor

Trials

96

Recruited

12,700+

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC10249237/

Improving difficult peripheral intravenous access requires ... Up to 67% of first insertion attempts are unsuccessful, and 10–45% of patients require upwards of three insertion attempts [3, 4].

2. sciencedirect.com sciencedirect.com/science/article/pii/S002074892100242X

Peripheral intravenous catheter failure: A secondary ... Of 11,830 peripheral intravenous catheters (8,200 participants) failure occurred in 36% (n = 4,263). Occlusion/infiltration incidence was 23% (n = 2,767), ...

3. onlinelibrary.wiley.com onlinelibrary.wiley.com/doi/10.1111/acem.15004

Long guidewire peripheral intravenous catheters in ... There was no difference in PIVC failure (134.0 per 1000 catheter days [GW-PIVC] vs. 111.8 [standard PIVC] per 1000 catheter days, hazard ratio ...

4. nature.com nature.com/articles/s41598-025-00301-1

Short versus long peripheral intravenous catheters in ... Accidental removals were lower in n-LPCs (0.3% versus 2.6%, p < 0.001). n-LPCs had higher rates of phlebitis (16.1% versus 6.6%, p < 0.001) and ...

5. journals.lww.com journals.lww.com/md-journal/fulltext/2025/10100/a_retrospective_cohort_study_on_the_use_of.135.aspx

A retrospective cohort study on the use of ultrasound in... Ultrasound-guided peripheral IV access has been shown in this study to enhance clinical outcomes among ED patients with DIVA.Compared with ...

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC12041681/

Safety and efficacy of a new long peripheral catheter in ... Conclusions: The new long peripheral catheter provides a safe, rapid, and effective means of venous access. Its straightforward insertion ...

7. nature.com nature.com/articles/s41598-025-12551-0

Comparative safety and efficacy of midline catheters versus ... The catheter failure rate was significantly lower in the MC group than in the LPC group (10.71% vs. 20.54%, P = 0.043), consistent with previous ...

8. bmchealthservres.biomedcentral.com bmchealthservres.biomedcentral.com/articles/10.1186/s12913-023-09499-0

Improving difficult peripheral intravenous access requires ... This study aims to co-design interventions that optimise ultrasound guided PIVC insertion in patients with DIVA, implement and evaluate these initiatives and ...