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A Cluster of Failures of Midline Catheters in a Hospital in the Home Program

A Retrospective Analysis

Dickson, Hugh G. PhD, MBBS, FACRM, FAFRM (RACP), OAM; Flynn, Olivia BMed; West, Dana RN; Alexandrou, Evan PhD, MPH, RN; Mifflin, Nicholas RN, BN, Grad Cert ICU; Malone, Matthew PhD, FFPM RCPS (Glasg)

doi: 10.1097/NAN.0000000000000330
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A cluster of 11 midline catheter failures occurred during a 2-week period in a Hospital in the Home program in an urban tertiary hospital in Australia. These failures prompted a 4-month retrospective audit of patients receiving outpatient antimicrobial therapy between December 1, 2016 and March 1, 2017. Primary outcomes were dwell time and catheter failure. Peripherally inserted central catheters had significantly fewer failures and significantly longer dwell times compared with midline catheters. Women experienced higher rates of midline catheter failure than men. The proportion of patients with midline catheters receiving continuous infusions who experienced a failure was markedly higher than those receiving bolus doses. Suggestions for further related research are discussed.

Liverpool Hospital, South Western Sydney Local Health District, Sydney, Australia (Drs Dickson, Alexandrou, and Malone, Mss Flynn and West, and Mr Mifflin); University of New South Wales, Sydney, Australia (Dr Dickson and Ms Flynn); Western Sydney University, Sydney, Australia (Drs Alexandrou and Malone, and Mr Mifflin); and AVATAR Group at Menzies Health Institute at Griffith University, Queensland, Australia (Dr Alexandrou).

Hugh G. Dickson, PhD, MBBS, FACRM, FAFRM (RACP), OAM, is a senior staff specialist at Liverpool Hospital in the South Western Sydney Local Health District. He is also a conjoint professor of aged care and rehabilitation in the South Western Sydney Clinical School at the University of New South Wales. Dr Dickson practices as a consultant physician in ambulatory care with particular interests in wound care and neuropathic ulceration. His major research interests are in basic measurement in health.

Olivia Flynn, BMed, is a medical practitioner and medical registrar at Liverpool Hospital. She is currently training as a specialist physician with the Royal Australasian College of Physicians. As part of her training in adult medicine, she reviews inpatients and outpatients who receive parental antibiotics via midline and peripherally inserted central catheters.

Dana West, RN, is the coordinator of the Hospital in the Home service at Liverpool Hospital.

Evan Alexandrou, PhD, MPH, RN, is a clinical nurse consultant in the intensive care unit at Liverpool Hospital, where he coordinates the central venous access service (CVAS). The CVAS is an internationally renowned program for its clinical expertise in vascular access procedures. Dr Alexandrou is involved in clinical education at an undergraduate and postgraduate level for nursing and medical training programs. He is a senior lecturer with the School of Nursing and Midwifery at Western Sydney University, a conjoint lecturer with the Faculty of Medicine at the University of New South Wales, and an adjunct associate professor with the AVATAR Group based in the Menzies Health Institute at Griffith University in Queensland.

Nicholas Mifflin, RN, BN, Grad Cert ICU, is a clinical nurse consultant for the CVAS, operated within the intensive care unit at Liverpool Hospital. Mr Mifflin is involved in clinical education at an undergraduate and postgraduate level for nursing and medical training programs. His membership in the Collaborative for Innovation in Vascular Access allows ongoing contribution to projects directed at clinical innovation, education, and research within the specialty of vascular access.

Matthew Malone, PhD, FFPM RCPS (Glasg), is the current director of research for the newly established South Western Sydney Limb Preservation and Wound Research Academic Unit and the head of the department for High-Risk Foot Service at Liverpool Hospital. Dr Malone was recently appointed as a senior lecturer in infectious diseases and microbiology at Western Sydney University's School of Medicine, where he completed his PhD. Dr Malone is also a fellow of the Faculty of Podiatric Medicine, Royal College of Physicians and Surgeons of Glasgow. He is a member of the International Working Group for the Diabetic Foot, the Global Wound Biofilm Expert Panel, and the Australian Society of Microbiology, Biofilm special interest group.

Corresponding Author: Hugh G. Dickson, PhD, MBBS, FACRM, FAFRM (RACP), OAM, Director Ambulatory Care, Liverpool Hospital, Locked Bag 71203, Liverpool BC NSW 1871, Australia (hugh.dickson@health.nsw.gov.au).

The authors of this article have no conflicts of interest to disclose.

© Copyright 2019 by Infusion Nurses Society