# Midline catheters in cancer care: when to use one, insertion, care and limits

Source: https://onco.cc/protocols/midline-catheters-for-anticancer-therapy/  
OnCo record `midline-catheters-for-anticancer-therapy` (Protocol). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

A midline is a longer drip tube put into a vein in the upper arm, with its tip still in the arm rather than near the heart. It avoids repeated needles, and it carries fewer bloodstream infections than a PICC. Whether it is safe for chemotherapy that can damage tissue if it leaks has not been settled.

## Summary

A midline is a peripheral device: its tip lies in the upper arm or axillary vein, not in a central vein. CDC/HICPAC (2011) advises a midline or PICC instead of a short cannula when intravenous therapy will likely exceed six days (Category II), daily site checks, replacement only for a specific indication (II), and prompt removal when it is no longer essential (IA). The Italian SIMiC bundle (2026) sets seven insertion steps: ultrasound assessment of the arm and chest veins, choice of an upper-arm vein, hand hygiene, antisepsis and maximal barrier precautions, ultrasound-guided puncture, intra-procedural ultrasound tip location, sutureless securement and glue with a transparent dressing.

Against PICCs, a 2026 meta-analysis of 15 studies (over 27,000 patients) found PICCs had about four times the risk of catheter-related bloodstream infection (RR 4.18), with no difference in thrombosis, failure, occlusion or phlebitis; a second 2026 meta-analysis (29,680 catheters) found similar venous thromboembolism rates (3.5% against 3.8%). In cancer, a Japanese prospective study of 59 patients having continuous fluorouracil for at least four days found no phlebitis with a midline; and a systematic review found midlines and PICCs safe for symptom control in palliative care. The open question is vesicants: no guideline read says whether continuous or repeated vesicant chemotherapy may run through a midline, and the Japanese extravasation guideline cites a case report of oxaliplatin extravasation from one.

## Fields

- Kind: Protocol
- Last checked: 2026-11-11
- Also known as: midline; midline catheter; MC; extended dwell peripheral catheter; midline for chemotherapy; midline vs PICC

## Connected records

- protocols: [Central venous catheter insertion for anticancer treatment: PICC, tunnelled line and implanted port](https://onco.cc/protocols/central-venous-catheter-insertion-for-anticancer-therapy/), [Choosing a venous access device for anticancer treatment: port, PICC, tunnelled line or cannula](https://onco.cc/protocols/venous-access-device-selection-for-anticancer-therapy/), [Peripheral cannula for anticancer treatment: vein choice, siting and checks, including vesicants](https://onco.cc/protocols/peripheral-cannula-for-anticancer-therapy/)
- technologies: [Catheter securement devices and dressings (SecurAcath, Tegaderm CHG)](https://onco.cc/technologies/catheter-securement-devices/), [Infusion pumps, ports, and ambulatory chemotherapy devices](https://onco.cc/technologies/infusion-devices-vascular-access/)
- drugs: [Fluorouracil (5-FU)](https://onco.cc/drugs/fluorouracil/)
- ideas: [Find out whether vesicant and irritant chemotherapy can safely run through a midline catheter](https://onco.cc/ideas/idea-upgrade-midline-vesicant-safety-study/)

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