Midlines Across Paediatrics (MAP): An implementation project across regional and tertiary paediatrics

Intravenous (IV) access is a vital part of healthcare, but peripheral intravenous catheters (PIVCs) can cause preventable harm to children. Over 800,000 children are admitted to hospital in Australia annually, distributed across tertiary, regional and rural settings and at least 50% of them will require a vascular access device. In paediatrics, PIVCs are the first choice, yet 40% PIVCs require multiple attempts, with 3% requiring >5 attempts. Once successfully inserted, 60% PIVCs provide a route for uninterrupted therapy administration and 1-5% are associated with significant complications such as extravasation injuries and bloodstream infections.

The Way Forward

Midline catheters are longer IV catheters, inserted in the upper arm. Their use can improve patient experience, they are safe and perform well in paediatrics. Midline catheters can be inserted by the same staff that insert PIVCs, with additional training. This is a healthcare intervention that should not be reserved for tertiary paediatrics. They are indicated for common peripherally-compatible therapies (e.g., hydration fluids, most antibiotics) for children requiring 4 or more days of treatment.

Our Shared Challenge

Midline catheters are rarely used in Australian paediatrics, with our CIRCAN survey demonstrating they are “never to rarely” used in 90% of sites, with minimal uptake of current guidelines and highly variable inserter training.

Our Joint Solution

This project brings together a dedicated group of practice, policy, and research experts to drive meaningful improvements in paediatric vascular care. Our vision is to eliminate unnecessary PIVC pain, complications, and reinsertions for children.

Investigators:
Professor Amanda Ullman, Dr Sarah McNab, Dr Richard McGee, Professor Samantha Jane Keogh, Ms Tricia Kleidon, Associate Professor David Tickell, Dr Roni Cole, Dr Jessica Costa-Pinto, Professor Robert Stuart Ware, Professor Joshua Michael Byrnes, Ms Eloise Borello, Ms Janelle Colquhoun, Dr Amanda Harley, Dr Tara Flemington, Dr Sean Beggs, Dr Mari Takashima, Ms Toni Day.
Partner Organisations and Investigators:
University of Queensland, Children’s Health Queensland Hospital and Health Service, Sunshine Coast University Hospital, Box Hill Hospital, Frankston Hospital, Ballarat Health Services, Royal Children’s Hospital, Campbelltown Hospital, Sydney Children’s Hospital, Westmead, Sydney Children’s Hospital, Randwick, Women’s and Children’s Hospital, Royal Hobart Hospital.