4-inch midline catheter versus long peripheral IV for adults with hard-to-find veins in the emergency department
Superior Ultrasound-Guided Venous Access: Single-Lumen Midline Catheters vs Long Peripheral IVs for Difficult IV Access in the Emergency Department, A Randomized Controlled Trial
This trial tests whether a 4-inch single-lumen midline catheter or a 4.78-cm long peripheral IV works better for adults in the emergency department who have difficult-to-access veins.
Quick facts
| Phase | Not applicable |
|---|---|
| Study type | Interventional |
| Enrollment | 270 (estimated) |
| Ages | 18 Years and up |
| Sex | All |
| Sponsor | Albany Medical College Academic / other |
| Locations | 1 site (Albany, New York) |
| Trial ID | NCT06668766 on ClinicalTrials.gov |
What this trial studies
Adults presenting to the Albany Medical Center ED with difficult IV access are assigned to receive either a 10-cm (4-inch) single-lumen midline catheter or a 4.78-cm long peripheral intravenous catheter placed with ultrasound guidance. Providers use standard ultrasound-guided insertion techniques and record metrics including first-pass success, number of attempts, time to secure access, catheter dwell time, and complications. The study also tracks blood-draw success and the need for rescue devices or escalation to central access. The goal is to compare device performance and patient-centered outcomes in a real-world emergency department population.
Who should consider this trial
Good fit: Adults aged 18 and older in the ED with difficult IV access—defined by multiple failed attempts, prior history of difficult access, or conditions associated with hard-to-find veins—are ideal candidates.
Not a fit: People without difficult IV access, children under 18, known prisoners, or those requiring immediate central or intraosseous access are unlikely to benefit from this comparison.
Why it matters
Potential benefit: If successful, this could reduce failed IV attempts and delays in care by providing more reliable peripheral access for patients with difficult veins.
How similar studies have performed: Prior studies suggest longer peripheral catheters have longer dwell times and lower early failure rates, but the use of midline catheters in the ED has been less frequently studied.
Eligibility criteria
Show full inclusion / exclusion criteria
Inclusion Criteria:
* Adult (age 18 and older) patients presenting to the AMC ED with difficult IV access defined as any of the following:
* Two failed attempts at landmark based IV or US-guided peripheral vascular access by qualified ED staff
* Self-reported history of difficult IV access and one of the following:
* History of requiring 2 or more IV attempts on a previous visit (either self-reported or documented in the electronic medical record)
* Previous requirement for a rescue device after failed IV access attempt. These devices are as follows:
* US guided PIV
* Midline catheter
* Peripherally inserted central catheter
* Central venous catheter
* Intraosseous catheter
* History of or active comorbid disease state with known difficult IV access
* Prior or current implanted port device
* End stage renal disease with fistula
* Sickle cell disease
* History of or active intravenous drug use
Exclusion Criteria:
* Patients under the age of 18
* Known Prisoners
* Non-English-speaking patients
* Patients in whom the device cannot be stabilized due to tissue or treatments in bilateral extremities or available extremity (burns, complex humeral fractures, dialysis fistulas etc.)
* Patients lacking capacity to consent
* Patients unable to sign written consent
* Patients without identifiable target veins by ultrasonography
* Known pregnant patients
* Previously enrolled in this study
* Previously withdrawn from this study
* Presented when no study IV proceduralists are available
* Patients in whom obtaining informed consent and being enrolled in the study would put them at risk for obtaining time sensitive medical care
Where this trial is running
Albany, New York
- Albany Medical Center Hospital — Albany, New York, United States (Recruiting)
Study contacts
- Study coordinator: Alexander Bracey, MD
- Email: braceya@amc.edu
- Phone: 518-262-3755
How to participate
- Review the eligibility criteria above with your treating physician.
- Visit the official trial page on ClinicalTrials.gov for the most current contact information and recruitment status.
- Contact the listed study coordinator or principal investigator to request pre-screening. Pre-screening is free and never obligates you to enroll.