Trial reportBMJ open2026
Central venous versus short midline catheter in difficult intravenous access patients: a randomised clinical pilot trial.
Trial report in BMJ open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT06719869 (Central Venous Catheter vs Midline in Difficulty Access Patient - A Randomized Controlled Clinical Pilot Trial - Pilot-ACCESS-D), which is not on this map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
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Central Venous Catheter vs Midline in Difficulty Access Patient - A Randomized Controlled Clinical Pilot Trial - Pilot-ACCESS-D
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Corrections and comments
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Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundPatients with difficult intravenous access (DIVA) are at increased risk of delays, discomfort and complications due to multiple failed intravenous access attempts. However, evidence comparing commonly used alternatives, short midline catheters (SMLs) and central venous catheters (CVCs) in this population is limited.
objectiveTo evaluate the feasibility of a larger randomised controlled trial comparing SMLs with CVCs in DIVA patients using predefined feasibility outcomes.
designThis trial was a pragmatic, open-label, single-centre, randomised controlled pilot trial with 1:1 randomisation. Participants were recruited from January to August 2025 with follow-up until September 2025.
settingRyhov County Hospital, Jönköping, a teaching county hospital in Sweden.
participantsAdult patients (≥18 years) with DIVA, requiring intravenous therapy for 4-29 days.
interventionsPatients received either a 10-cm SML in the upper arm or a single- or double-lumen CVC in the jugular or subclavian vein. PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcomes were feasibility criteria: eligibility, recruitment, retention, adherence, missing data and skin puncture attempts. Secondary outcomes included insertion and dwell time, and catheter complications (infection, thrombosis and malfunction).
resultsOf 73 patients screened, 40 (55%) were eligible and 30 (75%) (15 males (50%); median (IQR) age, 73 (61-82) years) were randomised to receive SML (n=15) or CVC (n=15). Three patients in the SML group were not included in the data analysis due to one failed insertion and two incomplete follow-ups. Retention (93%), adherence (97%) and missing data (0%) fulfilled predefined thresholds. The only criterion not met was the number of skin puncture attempts, with 52% of patients requiring two or more. Median catheter dwell time was 5.5 days for SML and 4.0 days for CVC. Complication rates per 1000 catheter days were 101.4 for SML versus 9.1 for CVC, primarily due to a higher rate of malfunction in SML (58% versus 7%). No infections or thromboses were observed.
conclusionThis pilot trial met all but one feasibility criterion, demonstrating that a larger randomised controlled trial is achievable. The findings highlight practical challenges, particularly related to puncture attempts and catheter performance, that should be addressed in the design of a definitive trial. TRIAL REGISTRATION NUMBER: NCT06719869.
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