Catheter-related thrombosis (CRT) and the fibroblastic sleeve (FS) are common complications of venous catheters. The FS has got a higher incidence compared to CRT, both in central and peripheral venous catheters. However, no study evaluated the incidence and the risk of these two non-infectious complications in midline catheters placed in patients admitted to intensive respiratory care units.
Objective:
The purpose of this prospective study is to describe the incidence of CRT and FS in midline catheters in intensive care setting and to investigate the association between these events and the clinical characteristics of patients.
Materials and methods:
The study carried out at “San Filippo Neri” Hospital in Rome since May 2023 to April 2024 evaluated the outcomes of midline catheter placement in adult patients admitted to the respiratory intensive care unit. Catheters were placed using the “GAVeCeLT SIP protocol,” with ultrasounds performed 7–10 days post-insertion (T1) and before removal (T2) in order to monitor complications like CRT and FS. Data were analyzed using Jamovi 2.0, focusing on catheter safety and related issues in critically ill patients.
Results:
In total, 33 patients were recruited in the study. The incidence of symptomatic CRT was 15.2% (5 cases), while asymptomatic cases accounted for 12.1% (4 cases). The incidence of the FS was 24.2% (8 cases). Statistical analysis showed that patients with CRT had significantly lower Barthel Index scores, compared to those without thrombosis.
Conclusion:
Midline catheters are safe even in intensive care settings. However, special attention should be reserved to patients with severe functional limitations of the upper limbs.
PanteliasK.Vascular access today. World J Nephrol2012; 1(3): 69.
2.
PittirutiMVan BoxtelTScoppettuoloG, et al. European recommendations on the proper indication and use of peripheral venous access devices (the ERPIUP consensus): a WoCoVA project. J Vasc Access2023; 24(1): 165–182.
3.
Citla SridharDAbou-IsmailMYAhujaSP. Central venous catheter-related thrombosis in children and adults. Thromb Res2020; 187: 103–112.
4.
FabianiAAversanaNSantoroM, et al. Complications associated to midline- and long peripheral catheters in adults. Systematic review of literature and proposal for a standardized model for data collection. Thromb Res2024; 236: 117–126.
5.
TimsitJFTabahAMimozO.Update on prevention of intra-vascular accesses complications. Intensive Care Med2022; 48(10): 1422–1425.
6.
López-RubioMLago-RodríguezMOOrdieres-OrtegaL, et al. A comprehensive review of catheter-related thrombosis. J Clin Med2024; 13(24): 7818.
7.
ZacconeVSantoroLGuerrieriE, et al. Prevention and treatment of catheter-related venous thrombosis in long-term parenteral nutrition: a SINuC position statement. Front Nutr2023; 10: 1106327.
8.
LagunaJCCooksleyTAhnS, et al. Catheter-related thrombosis (CRT) in patients with solid tumors: a narrative review and clinical guidance for daily care. Support Care Cancer2022; 30(10): 8577–8588.
9.
PassaroGPittirutiMLa GrecaA.The fibroblastic sleeve, the neglected complication of venous access devices: a narrative review. J Vasc Access2021; 22(5): 801–813.
10.
BalsoranoPVirgiliGVillaG, et al. Peripherally inserted central catheter–related thrombosis rate in modern vascular access era—when insertion technique matters: a systematic review and meta-analysis. J Vasc Access2020; 21(1): 45–54.
11.
TripathiSKumarSKaushikS.The practice and complications of midline catheters: a systematic review. Crit Care Med2021; 49(2): e140–e150.
12.
BahlAKarabonPChuD.Comparison of venous thrombosis complications in midlines versus peripherally inserted central catheters: are midlines the safer option?Clin Appl Thromb Hemost2019; 25: 1076029619839150.
13.
ChopraVKaatzSSwaminathanL, et al. Variation in use and outcomes related to midline catheters: results from a multicentre pilot study. BMJ Qual Saf2019; 28(9): 714–720.
14.
LisovaKHromadkovaJPavelkováK, et al. The incidence of symptomatic upper limb venous thrombosis associated with midline catheter: prospective observation. J Vasc Access2018; 19(5): 492–495.
15.
PinelliFBalsoranoPMuraB, et al. Reconsidering the GAVeCeLT Consensus on catheter-related thrombosis, 13 years later. J Vasc Access2021; 22(4): 501–508.
16.
HelmsJKimmounABertolettiL.Catheter-related thromboses in critically ill patients: are they worth looking for?Intensive Care Med2023; 49(4): 434–436.
17.
BenZWangJZhanJ, et al. Ultrasonic characteristics of inserted central catheter related fibroblastic sleeve. Sci Rep2025; 15(1): 4319.
18.
ObaidOSkorczewskiJPatelA, et al. Infected retained catheter-related sheath, an underrecognized complication of central venous catheter insertion: a case report. Am J Case Rep2022; 23: e936290.
19.
TrezzaCCalifanoCIovinoV, et al. Incidence of fibroblastic sleeve and of catheter-related venous thrombosis in peripherally inserted central catheters: a prospective study on oncological and hematological patients. J Vasc Access2021; 22(3): 444–449.
20.
MogiNNakagawaMMatsumaeH, et al. Fibrin sheath of a peripherally inserted central catheter undepicted with gray-scale (real-time B-mode) ultrasonography: a case report. Radiol Case Rep2018; 13(3): 537–541.
21.
CutuliSLDell’AnnaAMCarelliS, et al. Catheter-related thrombosis in critically ill patients: a clinical problem or just a matter of definition?Intensive Care Med2023; 49(7): 878–879.
22.
MaňásekVZapletalováJOlosováL, et al. Aetiology and management of persistent withdrawal occlusion in venous ports in oncology patients. Sci Prog2024; 107(3): 00368504241260374.
23.
FabianiAReginatoAPolettiA, et al. The dark side of the fibroblastic sleeve: case report and literature review. J Vasc Access2025; 26(6): 2128–2132.
24.
FabianiAAversanaNSantoroM, et al. The longer the catheter, the lower the risk of complications: results of the HERITAGE study comparing long peripheral and midline catheters. Am J Infect Control2024; 52(11): 1289–1295.
25.
GovindanSJobeAO’MalleyME, et al. To PICC or not to PICC? A cross-sectional survey of vascular access practices in the ICU. J Crit Care2021; 63: 98–103.
26.
NickelB.Does the midline peripheral intravenous catheter have a place in critical care?Crit Care Nurse2021; 41(6): e1–e21.
27.
ThomsenSLBoaRVinter-JensenL, et al. Safety and efficacy of midline vs peripherally inserted central catheters among adults receiving IV therapy: a randomized clinical trial. JAMA Netw Open2024; 7(2): e2355716.
28.
LoonFHJVPuijnLAPMHoutermanS, et al. Development of the A-DIVA scale: a clinical predictive scale to identify difficult intravenous access in adult patients based on clinical observations. Medicine (Baltimore)2016; 95(16): e3428.
29.
BresciaFPittirutiMSpencerTR, et al. The SIP protocol update: eight strategies, incorporating Rapid Peripheral Vein Assessment (RaPeVA), to minimize complications associated with peripherally inserted central catheter insertion. J Vasc Access2024; 25(1): 5–13.
30.
CharlsonMEPompeiPAlesKL, et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis1987; 40(5): 373–383.
31.
MahoneyFIBarthelDW.Functional evaluation: the Barthel Index. Md State Med J1965; 14: 61–65.
32.
Von ElmEAltmanDGEggerM, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol2008; 61(4): 344–349.
33.
PinelliFPittirutiMAnnettaMG, et al. A GAVeCeLT consensus on the indication, insertion, and management of central venous access devices in the critically ill. J Vasc Access2025; 26(4): 1096–1114.
34.
EngbersMJBlomJWCushmanM, et al. The contribution of immobility risk factors to the incidence of venous thrombosis in an older population. J Thromb Haemost2014; 12(3): 290–296.
35.
YaoYChaiSQiaoL, et al. An analysis of the prevalence and risk factors of deep vein thrombosis in non-fracture patients awaiting total hip arthroplasty: a retrospective study of 1244 cases. J Orthop Surg Res2024; 19(1): 84.
36.
GirardiLDi NisioMCandeloroM, et al. Catheter-related deep vein thrombosis: where are we at and where are we going? Updates and ongoing unmet clinical needs. Eur J Clin Invest2025; 55(1): e14311.
37.
SalinaroGPirroneMCardoneC, et al. Effects of positive airway pressure on basilic vein diameter and venous flow velocity in healthy volunteers. J Vasc Access2022; 25(3): 928–934.
38.
OstroffMDMoureauNPittirutiM.Rapid Assessment of Vascular Exit Site and Tunneling Options (RAVESTO): a new decision tool in the management of the complex vascular access patients. J Vasc Access2023; 24(2): 311–317.
39.
GidaroASamartinFSalviE, et al. Midline peripheral catheters inserted in the superficial femoral vein at mid-thigh: wise choice in COVID-19 acute hypoxemic respiratory failure patients with helmet continuous positive airway pressure. J Vasc Access2023; 24(6): 1469–1476.
40.
AnnettaMGBarbatoGPisciaroliE, et al. Central venous catheter-related thrombosis in patients with amyotrophic lateral sclerosis. J Vasc Access2025; 26(4): 1180–1186.
41.
AnnettaMGElliSMarcheB, et al. Femoral venous access: state of the art and future perspectives. J Vasc Access2025; 26(2): 361–371.
42.
LiuGDMaWJLiuHX, et al. Risk factors associated with catheter-related venous thrombosis: a meta-analysis. Public Health2022; 205: 45–54.
43.
NickelBGorskiLKleidonT, et al. Infusion therapy standards of practice, 9th edition. J Infus Nurs2024; 47(1S): S1–S285.
44.
PassaroGOrtolaniELandolfiE, et al. Incidence of fibroblastic sleeve in midline catheters: a pilot study in a non-intensive medical department. J Vasc Access. Epub ahead of print 16 July 2025. DOI: 10.1177/11297298251356774.
45.
JenaNAnanthasubramaniamK.Ghost catheter fibrin sleeve: case report and literature review. CASE (Phila)2020; 4(5): 405–409.
