• Barb Nickel.
• Barb Nickel is the critical care clinical nurse specialist for CHI Health St. Francis, Grand Island, Nebraska. She is a member of the Infusion Nurses Society Standards of Practice Committee.
• Crit Care Nurse. 2021 Dec 1; 41 (6): e1-e21.

BackgroundThe goals of infusion therapy are to preserve vascular health and safely deliver needed treatment. Achieving these goals is challenging in critical care because of the complexity of the treatment required. Daily justification of retaining an existing central venous catheter also creates urgency to change to a peripheral vascular access device. The midline catheter has had a resurgence in use because of the need for a long-term peripheral vascular access device not linked to central catheter-associated bloodstream infection risk.ObjectiveTo review the characteristics of midline catheters, the benefits and risks of midline catheters, and current evidence regarding midline catheter use in critical care.ResultsResearch related to midline catheters has greatly expanded the body of knowledge regarding vascular access device selection and midline catheter use.DiscussionAlthough the quality and results of research on vascular access devices vary widely, a more accurate safety profile is emerging to illustrate how midline catheter use can support the goals of infusion therapy.ConclusionsOptimizing vascular access device selection requires recognition that every vascular access device can cause patient harm. Although the midline catheter appears to fill an important niche in infusion therapy, use of the midline catheter should be carefully evaluated. Midline catheters should not be used as a catheter-associated bloodstream infection prevention strategy, should be inserted to administer peripherally compatible solutions, and should be considered for short-term continuous vesicant therapy only in emergent situations until more definitive vascular access can be achieved.©2021 American Association of Critical-Care Nurses.

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