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This observational study evaluated the clinical utility of ultrasound-guided midline catheters (MCs) for the delivery of cardiovascular medications in the cardiovascular intensive care unit (CICU). Conducted at a tertiary hospital in China between 2020 and 2022, 387 critically ill CICU patients (median age 78 years) requiring multi-drug infusions were analysed. MCs demonstrated a median dwell time of 9 days (IQR: 6-13 days), successfully administering 13 cardiovascular medications, including vasopressors and antiarrhythmics. Complication rates were remarkably low (1.3%), with two lumen occlusions, two haemorrhages, and one phlebitis. No central line-associated bloodstream infections (CLABSIs) or symptomatic thromboses occurred. Compared to central venous catheters (CVCs), MCs reduced insertion complexity and infection risk while maintaining efficacy for prolonged therapy. The findings support MCs as a safe alternative to traditional CVCs in CICU settings, particularly for elderly patients with complex comorbidities. Nurses performed most insertions (78%), highlighting procedural accessibility. This study underscores the value of ultrasound-guided MCs in optimising vascular access strategies for critical cardiovascular care. Key Words: Midline catheter, Central venous catheter, Peripherally inserted central catheter, Cardiovascular intensive care unit.