Which is the safer option for adult patients between peripherally inserted central catheters and midline catheters: a meta-analysis.

IF 3 4区医学 Q2 INFECTIOUS DISEASES Infection Control and Hospital Epidemiology Pub Date : 2024-11-13 DOI:10.1017/ice.2024.190

Jianyun Wen, Shuping Xiong, Ziwei Tu, Ping Lin, Yeqin Yuan, Wenhong Fu, Juan Qiu

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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.

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外周置入中心导管和中线导管哪一种对成年患者更安全：一项荟萃分析。

背景：外周置入中心导管（PICC）和中线导管（MC）被广泛用于肿瘤和重症患者的静脉输液。然而，关于哪种方法更优越仍存在争议。这项荟萃分析系统地比较了这两种静脉导管插入方法的安全性差异：通过在 6 个数据库中进行检索，确定了比较 PICC 和 MC 的合格研究。血栓形成是主要终点，次要终点包括其他并发症、成本和满意率：对 14 项研究的 20,675 名患者进行了分析。根据患者数据，MC 组的导管相关浅静脉血栓（SVT）（风险比 [RR]：0.42 [0.28，0.64]）、浸润（RR：0.27 [0.12，0.62]）和渗漏（RR：0.16 [0.05，0.53]）发生率较高。相比之下，PICC 组发生的导管相关血流感染更多（RR：1.95 [1.15, 3.32]）。考虑到导管天数，MC 组的总并发症（RR：0.51 [0.26, 0.99]）、导管相关血栓（深静脉血栓 [DVT] +SVT）（RR：0.41 [0.18, 0.95]）和渗漏（RR：0.17 [0.05, 0.64]）均有所增加。在 PICC 组，前 3 种并发症分别是导管堵塞（每 1000 个导管天数 [CD] 中有 20 例）、疼痛（每 1000 个导管天数 [CD] 中有 15 例）和静脉炎（每 1000 个导管天数 [CD] 中有 11 例）；在 MC 组，前 3 种并发症分别是渗漏（每 1000 个导管天数 [CD] 中有 33 例）、过早拔管（每 1000 个导管天数 [CD] 中有 22 例）和导管相关深静脉血栓（每 1000 个导管天数 [CD] 中有 22 例）。此外，PICC 组的不满意率更高（RR：4.77 [2.33, 9.77]），费用也有所增加：结论：与 MC 相比，PICC 似乎是成年患者更安全的静脉导管插入术选择，并发症更少。然而，PICC 的相关费用较高，满意度较低，值得高度重视。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Infection Control and Hospital Epidemiology 医学-传染病学

CiteScore

6.40

自引率

6.70%

发文量

289

审稿时长

3-8 weeks

期刊介绍： Infection Control and Hospital Epidemiology provides original, peer-reviewed scientific articles for anyone involved with an infection control or epidemiology program in a hospital or healthcare facility. Written by infection control practitioners and epidemiologists and guided by an editorial board composed of the nation''s leaders in the field, ICHE provides a critical forum for this vital information.