Objective To explore the evidence-based progress in the clinical application of medium-length catheters (MC), with a focus on analyzing hemodynamic-based tip positioning strategies, catheterization technique refinements, and evidence for complication prevention.

Methods A search strategy was developed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Two independent researchers conducted searches across PubMed, EMBASE, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang Data, and VIP databases from January 2010 to December 2024. A total of 42 relevant studies were included, of which 17 were randomized controlled trials (RCTs) eligible for pooled analysis.

Results Placing the catheter tip in the distal subclavian or axillary vein significantly reduced the risks of phlebitis and leakage compared to positioning in superficial upper arm veins, potentially attributable to higher local blood flow velocity (approximately 300 mL/min) in this region. The blunt dissection sheath insertion technique minimized bleeding at the puncture site. The incidence of catheter-related bloodstream infection (CRBSI) with MC was lower than that with central venous access, whereas the incidence of catheter-related venous thrombosis (CRVT) was higher than that with peripherally inserted central catheters (PICC).

Conclusion MC represent a safe and cost-effective mid-to-short-term venous access device. Hemodynamic-based tip positioning and standardized catheterization techniques contribute to reducing complication risks; however, further optimization of evidence-based application pathways requires additional high-quality, large-sample prospective studies.