# Midline catheters (peripheral venous catheters 3 to 8 inches long)

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OnCo record `midline-catheters` (Technology). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

A midline is a thin tube put into a vein near the inside of the elbow or the upper arm. It is longer than an ordinary drip but stops short of the large veins near the heart, so it suits treatments that last more than a few days but are not too harsh for a smaller vein.

## Summary

The CDC/HICPAC catheter guideline (2011, last updated 2017) describes a midline catheter as 3 to 8 inches long, "inserted via the antecubital fossa into the proximal basilic or cephalic veins", one that "does not enter central veins". It notes lower rates of phlebitis than short peripheral catheters and lower rates of infection than central venous catheters, and cites a prospective study of 140 midlines with a bloodstream infection rate of 0.8 per 1,000 catheter days, in place for a median of 7 days and up to 49. Its recommendations are to use a midline or a PICC instead of a short peripheral catheter when intravenous therapy will likely last more than six days, and to replace midlines only when there is a specific indication.

Because the tip lies in a peripheral vein, the choice between a midline and a central line in cancer care turns on what will be infused and for how long. The MAGIC-ONC panel (2025) rated device choice for adults with cancer by cancer type, urgency, infusate and planned dwell time; for chemotherapy in solid tumours it rated a single-lumen tunnelled central venous catheter or an implanted port as appropriate.

## Fields

- Kind: Technology
- Status: standard-of-care
- Last checked: 2026-11-11
- Also known as: Midline; Midline catheter; Midline IV
- Tags: supportive-care-gaps-2026-11
- Principle: A peripheral catheter long enough to sit in the larger upper-arm veins (basilic or cephalic) rather than the forearm, giving a longer dwell than a short cannula without the tip reaching the superior vena cava.
- Strengths: Longer dwell than a short peripheral cannula, so fewer repeated needles; Lower phlebitis rate than short peripheral catheters and lower infection rate than central lines (CDC 2011); Placed in an arm vein without a central venous puncture
- Limitations: The tip is not central, so infusates that need a central vein are not given through it; Not designed for the months-long dwell a port or tunnelled line provides; Anaphylactoid reactions have been reported with catheters made of elastomeric hydrogel (CDC 2011)

## Sources

- CDC/HICPAC: Guidelines for the Prevention of Intravascular Catheter-Related Infections, 2011 (last update October 2017), Table 1: https://www.cdc.gov/infection-control/media/pdfs/Guideline-BSI-H.pdf
- The Michigan Appropriateness Guide for Intravenous Catheters in Adult Patients With Cancer (MAGIC-ONC), Ann Intern Med 2025 (doi 10.7326/ANNALS-25-02523): https://europepmc.org/article/MED/41183333

## Connected records

- fronts: [Devices & Physical Therapies](https://onco.cc/fronts/devices/), [Supportive Care & Survivorship](https://onco.cc/fronts/supportive-care/)
- technologies: [Implanted ports for chemotherapy (port-a-cath, power-injectable, apheresis and intraperitoneal ports)](https://onco.cc/technologies/implanted-ports/), [Infusion pumps, ports, and ambulatory chemotherapy devices](https://onco.cc/technologies/infusion-devices-vascular-access/), [Peripherally inserted central catheters (PICC lines)](https://onco.cc/technologies/picc-lines/)
- terms: [Central venous access (port, PICC line)](https://onco.cc/terms/central-venous-access/)

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