Swaminathan L, Flanders S, Horowitz J, et al. - Improved patient safety could be ensured by judicious use of midlines over peripherally inserted central catheters (PICCs); randomized clinical trials to compare these devices seem obligatory.

• This is a cohort study including 10,863 patients across multiple hospitals who received 5,758 PICCs and 5,105 midlines for difficult access or short-term antibiotic therapy.

• Post-adjustments, a greater risk of developing a major complication was noted in patients who received PICCs vs those who received midlines (odds ratio, 1.99).

• Midlines, vs PICCs, were found to be related to fewer bloodstream infections (0.4% vs 1.6%) and catheter occlusions (2.1% vs 7.0%) but similar thrombosis events.

• If deep vein thrombosis risk is similar or greater with midlines vs PICCs for short-term use remains unclear.