By Hadi Salempoor and Kamran Zamanian, Ph.D., iData Research Inc.
The global midline catheter market currently boasts a valuation of approximately $185 million, with projections indicating it will approach $265 million by the end of 2030, reflecting a remarkable growth rate of roughly 40% and a CAGR of over 5%.
The Role Of Midline Catheters
Similar to peripherally inserted central catheters (PICCs) and peripheral intravenous catheters (PIVCs), midline catheters are placed peripherally in the patient’s arm. Like PICCs, midline catheters are placed in the basilic, cephalic, or brachial veins. Midlines are typically longer than PIVCs but shorter than PICCs, ranging from 8 cm to 20 cm in length. Because they are shorter than PICCs, midlines do not extend all the way toward a patient’s heart. Historically, older, more traditional midlines fall on the lengthier end (typically exceeding 12 cm), with both power-injectable and non-power-injectable products being offered, and all come in component-based kits for use of the modified Seldinger technique (MST) for insertions. Newer midline models tend to be shorter (less than 12 cm) and are almost exclusively power-injectable, and kits are sold for both MST and accelerated Seldinger technique (AST) insertions.
Midlines are generally used for two to four weeks and often for antibiotic therapy. Also, because midlines are shorter in length than PICCs and are not advanced into the superior vena cava (SVC), they are easier to place and more comfortable for patients. Central venous access is typically defined as allowing delivery or access directly to the SVC or right atrium. Therefore, midlines represent an intermediate product between PICCs and short PIVCs.
Historically, midlines were only used to infuse many of the same drugs as PIVCs, which proved a limitation when compared to PICCs. Some of the regulations regarding infusion of irritating drugs, such as vancomycin, have been loosened in recent years, and midlines are now the suggested form of vancomycin infusion for shorter-term care, as opposed to the use of PICCs and central venous catheters (CVCs).
Advantages Of Midline Catheters
The introduction of new midline catheters offers a practical treatment option for intermediate dwell applications. In these situations, midline catheters present a superior choice compared to short peripheral catheters, which are suitable for brief indwelling periods, and PICCs, which carry a higher risk of central line-associated bloodstream infection (CLABSI) and are more complex to insert. Some products in the market employ advanced technologies aimed at reducing thrombosis cases. These innovations typically come at a premium price, but their increased adoption will boost the overall market value of midline catheters.
Midline catheters are designed for patients in need of therapy lasting more than five days but less than a few weeks. They are inserted into the larger veins of the upper arm and tend to offer a longer duration of use compared to PIVCs. When compared to PICCs, midline catheters boast several advantages. They have a lower risk of local phlebitis and offer a quicker, less painful insertion process than PICCs.
Figure 1: Access iData’s Global Vascular Access Devices Market report to view more granular data.
COVID-19's Impact On The Midline Landscape
Ensuring prompt, secure, and durable vascular access for critically ill COVID-19 patients while minimizing the risk of viral transmission to healthcare personnel and equipment in the vicinity presents challenges. Recent studies have revealed differences in central vein access procedures between COVID-19 and non-COVID-19 patients1. Unusual vascular access is also common among critically ill COVID-19 patients2.
Studies have demonstrated that, in comparison to standard PICCs, midlines were a safe and effective alternative in COVID-19 patients3. The study concluded that midline catheters could be used as a first-line option for vascular access in COVID-19 patients.
Furthermore, their more affordable average selling price (ASP) compared to PICCs makes midline an attractive alternative choice. Consequently, during the COVID-19 pandemic, the midline market experienced substantial growth, with a notable 18% increase in market value in 2021, followed by a 10% rise in 2022. This underscores the increasing recognition of midline as a valuable resource in healthcare settings.
Figure 2: Access iData’s Global Vascular Access Devices Market report to view more granular data.
Reduced Complications And Cost Savings
PICCs are central venous catheters that are inserted through peripheral veins with their tips reaching the cavoatrial junction near the right atrium. While they offer the convenience of bedside placement and extended venous access, similar to other central lines, they come with potential complications such as CLABSI and deep vein thrombosis (DVT).
In contrast, midline catheters are peripheral vascular devices that are inserted into the upper extremity veins and terminate at or below the axillary vein, which is distal to the shoulder. Since they terminate outside the major vessels of the chest, some studies suggest that they are less likely to cause CLABSI or DVT. The development of appropriate criteria for choosing vascular access devices, increased awareness of complications related to PICCs, and financial penalties linked to CLABSI have led to a growing use of midlines in hospitalized patients. Many studies have shown a reduction in PICC usage and associated complications by replacing them with midlines in hospitalized patients4.
Expanding Competitive Landscape
In 2022, the global market for midlines experienced notable growth, with expectations of continued expansion in the coming years. Midlines, offering a more cost-effective option compared to PICCs, have garnered substantial interest. Future growth is anticipated to be primarily fueled by a substantial increase in unit sales, complemented by a moderate uptick in ASPs.
ASP increases across the midline market are expected to be modest throughout the forecast period. For midlines to continue being seen as a viable alternative to PICCs, it is likely that the midline ASP cannot grow to a point where it is comparable to PICCs. Price increases are also moderated by the growing presence of short AST midlines, which typically command a lower ASP than other products on the market.
The global market for midline catheters is experiencing significant growth and transformation, driven by various factors and evolving healthcare needs. Midline catheters, with their intermediate position between short peripheral catheters and PICCs, have become a valuable resource in healthcare settings. Their role in facilitating therapy for patients requiring treatment beyond five days but less than a few weeks is becoming increasingly recognized.
The advantages of midline catheters, including reduced risk of local phlebitis and a less painful insertion process compared to PICCs, have contributed to their expanding popularity. These catheters offer a practical solution for intermediate dwell applications, providing a balance between patient comfort and safety.
Furthermore, the COVID-19 pandemic highlighted the adaptability and cost-effectiveness of midline catheters. Their use as a first-line option for vascular access in COVID-19 patients has not only demonstrated their safety and effectiveness but also has accelerated their adoption.
The reduced complications associated with midlines, such as a lower risk of CLABSI and DVT, have made them a preferred choice. As healthcare professionals become more aware of these benefits, midlines are expected to play an even more prominent role in vascular access.
With a growing competitive landscape and expectations of continued expansion, the global market for midline catheters is poised for a promising future. Their cost-effectiveness, coupled with evolving technologies aimed at reducing thrombosis cases, is likely to drive growth in unit sales and moderate increases in ASPs. While the midline market continues to evolve, its position as a practical and safer alternative to other vascular access devices is becoming increasingly solidified.
- Gidaro, A., Vailati, D., Gemma, M., Lugli, F., Casella, F., Cogliati, C., ... & Giustivi, D. (2022). Retrospective survey from vascular access team Lombardy net in COVID-19 era. The journal of vascular access, 23(4), 532-537.
- Chun, T. T., Judelson, D. R., Rigberg, D., Lawrence, P. F., Cuff, R., Shalhub, S., ... & Woo, K. (2020). Managing central venous access during a healthcare crisis. Journal of vascular surgery, 72(4), 1184-1195.
- Gidaro, A., Samartin, F., Salvi, E., Casella, F., Cogliati, C., Giustivi, D., ... & Calloni, M. (2022). Midline peripheral catheters inserted in the superficial femoral vein at mid-thigh: wise choice in COVID-19 acute hypoxemic respiratory failure patients with helmet continuous positive airway pressure. The Journal of Vascular Access, 11297298221085450.
- Swaminathan, L., Flanders, S., Horowitz, J., Zhang, Q., O’Malley, M., & Chopra, V. (2022). Safety and outcomes of midline catheters vs peripherally inserted central catheters for patients with short-term indications: a multicenter study. JAMA internal medicine, 182(1), 50-58.
- iData Research Inc. Global Vascular Access Device and Accessories Market – 2023. https://idataresearch.com/product/vascular-access-devices-market
About The Authors:
Hadi Salempoor is a research analyst at iData Research. He works on research projects regarding the medical device industry, publishing the global Vascular Access Device and Accessories Market research report.
Kamran Zamanian, Ph.D., is CEO and founding partner of iData Research. He has spent over 20 years working in the market research industry with a dedication to the study of medical devices used in the health of patients all over the globe.