Comparative safety and effectiveness of midline catheters vs. peripherally inserted central catheters: a systematic review and meta-analysis

Background & objective – Peripherally inserted central catheters (PICCs) and midline catheters (MCs) are widely used for intravenous therapy, but their relative safety and effectiveness remain uncertain. This systematic review and meta-analysis aimed to compare complication rates between PICCs and MCs. Methods – We systematically searched PubMed, Scopus, Embase, and Web of Science for randomized controlled trials (RCTs) and observational studies evaluating PICCs vs. MCs. Risk of bias was assessed using the Cochrane RoB 2 tool for RCTs and the Newcastle-Ottawa Scale for observational studies. Meta-analyses were performed to calculate pooled risk ratios (RRs) and standardized mean differences (SMDs) with 95% confidence intervals (CIs). Results – Fifteen studies (3 RCTs and 12 cohort studies) including over 27, 000 patients were analyzed. PICCs were associated with a significantly higher risk of CRBSIs compared with MCs (RR = 4.18, 95% CI: 2.87–6.08; p < 0.01). No significant differences were observed between the two devices in rates of deep vein thrombosis (DVT), pulmonary embolism (PE), device failure, occlusion, dislodgement, catheter migration, phlebitis, or mortality. PICCs demonstrated longer dwell times (SMD = 0.68; 95% CI: 0.18–1.07; p < 0.01), consistent with their use in prolonged therapies. Conclusion – MCs are associated with a lower risk of bloodstream infections compared with PICCs. PICCs remain appropriate for long-term therapy, while MCs may represent a safer alternative for shorter courses. Device selection should be individualized based on patient risk factors, treatment duration, and clinical context.