Author:
Kai Knudsen
Updated:
27 August, 2025
This chapter explains midline venous catheters, including their indications, insertion methods, care practices, and strategies to prevent complications.
Midline
This catheter is 20 or 25 cm long. A midline catheter is inserted under ultrasound guidance and percutaneously through a vein in the upper arm, typically the basilic vein. These catheters are intended for both short- and medium-term use, 1-3 weeks. They can often replace a CVC for venous access. A small dose of local anesthetic, such as 1% Xylocaine, is first administered. Under sterile conditions, the basilic vein is punctured with the help of a tourniquet and ultrasound. After releasing the tourniquet, a guidewire is inserted into the vessel. Next, dilation is performed using a dilator, possibly with a small incision made with a sharp scalpel. The midline catheter is inserted about 20 cm over the guidewire, which is then removed. The catheter is secured with a special clamp that fastens it at skin level, and the clamp and catheter are taped with a special dressing.
A midline catheter provides vascular access via the upper arm, with a maximum length of 25 cm. The catheter’s tip lies in a peripheral vein before reaching the chest. A midline catheter is an alternative to a CVC and can remain in place longer than a conventional PVC (recommended for treatments lasting 5-28 days). However, it is generally reserved for patients who cannot receive a conventional PICC line or when the treatment requires IV access for more than 5 days. When irritating medications such as certain antibiotics or chemotherapy drugs are administered, a PICC line is preferred because the central position of the catheter’s tip allows for the diffusion of the medication in the high blood flow near the catheter tip.
Midline catheter
Rapid Infusion Catheter (RIC Line)
This is a thick, short catheter for rapid transfusions, with an inner diameter of 7.5 or 8 French. After identifying the vessel with a puncture needle and guidewire, the skin is lightly incised with a sharp scalpel. A 20-gauge catheter is inserted into a peripheral vein, and a guidewire is threaded through. A moderate skin incision is made with a scalpel blade, and the dilator (blue catheter) is inserted into the vein before the catheter is placed over the guidewire. It allows for rapid and large transfusions of blood products.
Regardless of the insertion technique or catheter type, the catheter tip should be placed in the superior vena cava and/or at the transition to the right atrium of the heart. The tip location is confirmed with an x-ray. The advantage of a central venous catheter is that the patient avoids the discomfort associated with frequent needle sticks and blood draws. Administering irritating medications through a peripheral vein is not without risk. Long-term need for a centrally located catheter is especially common in end-of-life care (pain relief, nutrition
Certofix Catheter
Certofix Trio is a powerful triple-lumen CVC from Braun that enables rapid infusions. It can be used as a standard CVC or for rapid transfusions in cases of major bleeding. Available in three different catheter lengths: 15, 20, or 30 cm. The outer diameter is 7 Fr with a soft catheter tip. The catheter has three different lumens of varying sizes: the distal end is 16 G, the middle one is 18 G, and the proximal one is 18 G. Two-part adjustable catheter fixation at the insertion site for suturing. Yellow base with the groove facing upwards. Secured with a green clamp that prevents catheter movement (included only with 20 cm and 30 cm lengths). Certofix Trio also features an ECG lead for real-time catheter tip positioning.
Certofix Duo, as the name suggests, has two lumens instead of three. Both lumens in the Certofix Duo are 16 G, slightly smaller than in the 3-lumen version.
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