Complications and predictors of catheter failure in pediatric long peripheral and midline catheters: a prospective observational study

Background The use of long peripheral catheters (LPCs) and midline catheters (MCs) in pediatric patients is increasing, although evidence regarding their safety and complications remains limited. Objective To describe complications associated with LPCs and MCs in pediatric patients and identify predictors of catheter failure. Methods A prospective observational study was conducted between July 2022 and March 2025 in pediatric patients (17 days–16 years) requiring LPC or MC insertion by nursing staff in a tertiary hospital. Demographic, clinical, catheter-related, and outcome variables were collected. Catheter failure was defined as non-elective removal before completion of planned intravenous therapy. Associations were analyzed using Mann–Whitney U, Fisher’s exact, or χ 2 tests. Results Sixty-nine catheters were included. Overall, 69.6% remained in place until completion of therapy, with a mean dwell time of 11.9 days (SD 7.97). The complication rate was 25.6 per 1000 catheter-days. Thrombosis was the most frequent complication (8.7%; 7.3 per 1000 catheter-days). Difficult venous access was significantly associated with catheter failure (p = 0.044), whereas no significant associations with thrombosis were identified. According to NAVIGATE nomenclature, catheters with axillary or subclavian tip locations were classified as MCs and those with more distal tips as LPCs. Conclusions LPCs and MCs allowed completion of intravenous therapy in most pediatric patients. Thrombosis was the most clinically relevant complication. Larger studies are needed to identify predictors of catheter failure and thrombosis.