No CrossRef data available.
Article contents
Which is the safer option for adult patients between peripherally inserted central catheters and midline catheters: a meta-analysis
Published online by Cambridge University Press: 13 November 2024
Abstract
Background:
Peripherally inserted central catheters (PICC) and midline catheters (MC) are widely used for intravenous infusions in oncology and critically ill patients. However, controversy remains regarding which method is superior. This meta-analysis systematically compares the safety differences between these 2 methods of intravenous catheterization.
Methods:
Eligible studies comparing PICC and MC were identified through searches in 6 databases. Thrombosis is the primary endpoint, while secondary endpoints include other complications, cost, and satisfaction rate.
Results:
Fourteen studies with 20,675 patients were analyzed. Based on patient data, the MC group exhibited higher rates of catheter-related superficial vein thrombosis (SVT) (risk ratio [RR]: 0.42 [0.28, 0.64]), infiltrations (RR: 0.27 [0.12, 0.62]), and leaks (RR: 0.16 [0.05, 0.53]). In contrast, the PICC group had more catheter-related bloodstream infections (RR: 1.95 [1.15, 3.32]). Considering catheter days, the MC group showed increased total complications (RR: 0.51 [0.26, 0.99]), catheter-related thrombosis (deep vein thrombosis [DVT]+SVT) (RR: 0.41 [0.18, 0.95]), and leaks (RR: 0.17 [0.05, 0.64]). In the PICC group, the top 3 complications were catheter occlusions (20 per 1,000 catheter days [CDs]), pain (15 per 1,000 CDs), and phlebitis (11 per 1,000 CDs); for the MC group, they were leaks (33 per 1,000 CDs), premature removals (22 per 1,000 CDs), and catheter-related DVT (22 per 1,000 CDs). Additionally, the PICC group had higher dissatisfaction rates (RR: 4.77 [2.33, 9.77]) and increased costs.
Conclusions:
Compared to MC, PICC appears to be a safer intravenous catheterization option for adult patients, exhibiting fewer complications. However, the higher associated costs and lower satisfaction rates of PICC warrant serious attention.
- Type
- Original Article
- Information
- Copyright
- © The Author(s), 2024. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America
References
Gifford, AH, Hinton, AC, Jia, S, Nasr, SZ, Mermis, JD, Lahiri, T, et al. Complications and practice variation in the use of peripherally inserted central venous catheters in people with cystic fibrosis: the prospective study of peripherally inserted venous catheters in people with cystic fibrosis study. Chest 2023;164:614–624.CrossRefGoogle ScholarPubMed
Usman, S, Cheema, MAI, Mustafa, S, Iftikhar, A. Fatal hemoptysis with pleural effusions secondary to superior vena cava obstruction as a complication of central venous catheterization. Cureus 2024;16:e59690.Google ScholarPubMed
Chen, P, Zhu, B, Wan, G, Qin, L. The incidence of asymptomatic thrombosis related to peripherally inserted central catheter in adults: a systematic review and meta-analysis People’s. Nurs Open 2021;8:2249–2261.CrossRefGoogle ScholarPubMed
Sebolt, J, Buchinger, J, Govindan, S, Zhang, Q, O’Malley, M, Chopra, V. Patterns of vascular access device use and thrombosis outcomes in patients with COVID-19: a pilot multi-site study of Michigan hospitals. J Thromb Thrombolysis 2022;53:257–263.CrossRefGoogle ScholarPubMed
Seo, H, Altshuler, D, Dubrovskaya, Y, Nunnally, ME, Nunn, C, Ello, N, et al. The Safety of midline catheters for intravenous therapy at a large academic medical center. Ann Pharmacother 2020;54:232–238.CrossRefGoogle Scholar
Swaminathan, L, Flanders, S, Horowitz, J, Zhang, Q, O’Malley, M, Chopra, V. Safety and outcomes of midline catheters vs peripherally inserted central catheters for patients with short-term indications: a multicenter study. JAMA Intern Med 2022;182:50–58.CrossRefGoogle ScholarPubMed
Sharp, R, Esterman, A, McCutcheon, H, Hearse, N, Cummings, M. The safety and efficacy of midlines compared to peripherally inserted central catheters for adult cystic fibrosis patients: a retrospective, observational study. Int J Nurs Stud 2014;51:694–702.CrossRefGoogle ScholarPubMed
Citla Sridhar, D, Abou-Ismail, MY, Ahuja, SP. Central venous catheter-related thrombosis in children and adults. Thromb Res 2020;187:103–112.CrossRefGoogle ScholarPubMed
Gornik, HL, Gerhard-Herman, MD, Misra, S, Mohler, ER 3rd, Zierler, RE; Peripheral vascular ultrasound and physiological testing part ii: testing for venous disease and evaluation of hemodialysis access technical panel; appropriate use criteria task force. ACCF/ACR/AIUM/ASE/IAC/SCAI/SCVS/SIR/SVM/SVS/SVU 2013 appropriate use criteria for peripheral vascular ultrasound and physiological testing part II: testing for venous disease and evaluation of hemodialysis access: a report of the American College of Cardiology Foundation appropriate use criteria task force. J Am Coll Cardiol 2013;62:649–65.CrossRefGoogle Scholar
Duijzer, D, de Winter, MA, Nijkeuter, M, Tuinenburg, AE, Westerink, J. Upper extremity deep vein thrombosis and asymptomatic vein occlusion in patients with transvenous leads: a systematic review and meta-analysis. Front Cardiovasc Med 2021;8:698336.CrossRefGoogle ScholarPubMed
Wells, GA, Shea, BJ, O’Connell, D, Peterson, J, Welch, V, Losos, M, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of non-randomised studies in meta-analyses. Available at http://www.ohri.ca/programs/clinical_epidemiology/oxford.htm. Accessed 2012.Google Scholar
Jadad, AR, Moore, RA, Carroll, D, Jenkinson, C, Reynolds, DJ, Gavaghan, DJ, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 1996;17: 1–12.CrossRefGoogle ScholarPubMed
Higgins, JP, Altman, DG, Gøtzsche, PC, Jüni, P, Moher, D, Oxman, AD, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ 2011;343:d5928.CrossRefGoogle ScholarPubMed
Sterne, JA, Sutton, AJ, Ioannidis, JP, Terrin, N, Jones, DR, Lau, J, et al. Recommendations for examining and interpreting funnel plot asymmetry in meta-analyses of randomised controlled trials. BMJ 2011;343:d4002.CrossRefGoogle ScholarPubMed
Bahl, A, Karabon, P, Chu, D. Comparison of venous thrombosis complications in midlines versus peripherally inserted central catheters: are midlines the safer option? Clin Appl Thromb Hemost 2019;25:1076029619839150.CrossRefGoogle ScholarPubMed
Bing, S, Smotherman, C, Rodriguez, RG, Skarupa, DJ, Ra, JH, Crandall, ML. PICC versus midlines: comparison of peripherally inserted central catheters and midline catheters with respect to incidence of thromboembolic and infectious complications. Am J Surg 2022;223:983–987.CrossRefGoogle ScholarPubMed
Caparas, JV, Hu, JP. Safe administration of vancomycin through a novel midline catheter: a randomized, prospective clinical trial. J Vasc Access 2014;15:251–256.CrossRefGoogle ScholarPubMed
Lescinskas, EH, Trautner, BW, Saint, S, Colozzi, J, Evertsz, K, Chopra, V, et al. Use of and patient-reported complications related to midline catheters and peripherally inserted central catheters. Infect Control Hosp Epidemiol 2020;41:608–610.CrossRefGoogle ScholarPubMed
Lisova, K, Paulinova, V, Zemanova, K, Hromadkova, J. Experiences of the first PICC team in the Czech Republic. Br J Nurs 2015;24:S4–S10.CrossRefGoogle ScholarPubMed
Marsh, N, Larsen, EN, O’Brien, C, Groom, P, Kleidon, TM, Alexandrou, E, et al. Comparing the use of midline catheters versus peripherally inserted central catheters for patients requiring peripherally compatible therapies: a pilot randomised controlled trial (the compact trial). Infect Dis Health 2023;28:259–264.CrossRefGoogle ScholarPubMed
Tao, F, Wang, X, Liu, J, Li, J, Sui, F. Perioperative application of midline catheter and PICC in Patients with gastrointestinal tumors. J BUON 2019;24:2546–2552.Google ScholarPubMed
Thomsen, SL, Boa, R, Vinter-Jensen, L, Rasmussen, BS. Safety and efficacy of midline vs peripherally inserted central catheters among adults receiving IV therapy: a randomized clinical trial. JAMA Netw Open 2024;7:e2355716.CrossRefGoogle ScholarPubMed
Tso, AR, Patniyot, IR, Gelfand, AA, Goadsby, PJ. Increased rate of venous thrombosis may be associated with inpatient dihydroergotamine treatment. Neurology 2017;89:279–283.CrossRefGoogle ScholarPubMed
Xu, T, Kingsley, L, DiNucci, S, Messer, G, Jeong, JH, Morgan, B, et al. Safety and utilization of peripherally inserted central catheters versus midline catheters at a large academic medical center. Am J Infect Control 2016;44:1458–1461.CrossRefGoogle Scholar
Zerla, PA, Canelli, A, Caravella, G. Open vs closed tip valved peripherally inserted central catheters and midlines: findings from a vascular access database. JAVA. 2015;20:169–176.CrossRefGoogle Scholar
Tripathi, S, Kumar, S, Kaushik, S. The practice and complications of midline catheters: a systematic review. Crit Care Med 2021;49:e140–e150.CrossRefGoogle ScholarPubMed
Lago, P, Tiozzo, C, Boccuzzo, G, Allegro, A, Zacchello, F. Remifentanil for percutaneous intravenous central catheter placement in preterm infant: a randomized controlled trial. Paediatr Anaesth 2008;18:736–44.CrossRefGoogle ScholarPubMed
Siddiqui, MT, Coughlin, KL, Koenen, B, Al-Yaman, W, Bestgen, A, Regueiro, M, et al. Association between tunneled catheter placement and catheter-associated deep venous thrombosis in adults with inflammatory bowel disease receiving home parenteral nutrition: a retrospective cohort study. JPEN J Parenter Enteral Nutr 2024;48:562–570.CrossRefGoogle ScholarPubMed
Liu, W, He, L, Zeng, W, Yue, L, Wei, J, Zeng, S, et al. D-dimer level for ruling out peripherally inserted central catheter-associated upper extremity deep vein thrombosis and superficial vein thrombosis. Nurs Open 2022;9:2899–2907.CrossRefGoogle ScholarPubMed
Sánchez Cánovas, M, García Torralba, E, Blaya Boluda, N, Sánchez Saura, A, Puche Palao, G, Sánchez Fuentes, A, et al. Thrombosis and infections associated with PICC in onco-hematological patients, what is their relevance? Clin Transl Oncol 2024. doi: 10.1007/s12094-024-03548-8.CrossRefGoogle ScholarPubMed
Zochios, V, Umar, I, Simpson, N, Jones, N. Peripherally inserted central catheter (PICC)-related thrombosis in critically ill patients. J Vasc Access 2014;15:329–37.CrossRefGoogle ScholarPubMed
Mai, YF, Cui, LW, Wang, G, Tan, QZ, Xian, SF, Pai, P. Meticulous catheter care and aseptic approach reduce catheter-related bloodstream infections significantly in hemodialysis patients: a 5-year single center study. J Vasc Access 2024:11297298241251507. doi: 10.1177/11297298241251507.CrossRefGoogle ScholarPubMed
Meto, E, Cabout, E, Rosay, H, Espinasse, F, Lot, AS, Hajjam, ME, et al. Cost comparison of four venous catheters: short peripheral catheter, long peripheral line, midline, and PICC for peripheral infusion. J Vasc Access 2024:11297298241258257. doi: 10.1177/11297298241258257.CrossRefGoogle ScholarPubMed
Chen, X, Yue, L, Liao, P, Li, B. Incidence and risk factors of neonatal peripherally inserted central catheter-related thrombosis: a systematic review and meta-analysis. Nurs Crit Care 2024. doi: 10.1111/nicc.13121.CrossRefGoogle ScholarPubMed
Lee, YM, Ryu, BH, Hong, SI, Cho, OH, Hong, KW, Bae, IG, et al. Clinical impact of early reinsertion of a central venous catheter after catheter removal in patients with catheter-related bloodstream infections. Infect Control Hosp Epidemiol 2021;42:162–168.CrossRefGoogle ScholarPubMed
Buchanan, C, Burt, A, Moureau, N, Murray, D, Nizum, N. Registered Nurses’ Association of Ontario (RNAO) best practice guideline on the assessment and management of vascular access devices. J Vasc Access 2024;25:1389–1402. doi: 10.1177/11297298231169468.CrossRefGoogle ScholarPubMed
Wen et al. supplementary material 1
Wen et al. supplementary material
File
66 KB
Wen et al. supplementary material 2
Wen et al. supplementary material
File
20 KB
Wen et al. supplementary material 3
Wen et al. supplementary material
File
15.9 KB
Wen et al. supplementary material 4
Wen et al. supplementary material
File
18.5 KB
Wen et al. supplementary material 5
Wen et al. supplementary material
File
86 KB