Effectiveness and Safety of Methods to Prevent Bloodstream and Other Infections and Noninfectious Complications Associated With Peripherally Inserted Central Catheters: A Systematic Review and Meta-Analysis.

IF 7.3 1区医学 Q1 IMMUNOLOGY Clinical Infectious Diseases Pub Date : 2026-03-17 DOI:10.1093/cid/ciaf063

Andreea Dobrescu, Alexandru Marian Constantin, Larisa Pinte, Andrea Chapman, Piotr Ratajczak, Irma Klerings, Robert Emprechtinger, Benedetta Allegranzi, Michael Lindsay Grayson, Joao Paulo Toledo, Gerald Gartlehner, Barbara Nussbaumer-Streit

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Abstract

Background: Peripherally inserted central catheters (PICCs) have a 29% complication rate. This systematic review evaluated 25 interventions to prevent PICC-associated infectious and noninfectious complications in participants of all ages.

Methods: We searched electronic databases (MEDLINE, Embase, Cochrane Library, World Health Organization Global Index Medicus, CINAHL) and reference lists for randomized (RCTs) and nonrandomized controlled trials published between 1 January 1980-8 May 2024. We dually selected studies, assessed risk of bias, extracted data, and rated certainty of evidence (COE). We included single interventions of interest and combinations of at least 2 (bundle/multimodal). If 3 or more RCTs existed, we conducted Bayesian random-effects meta-analyses.

Results: Seventy-four studies met our eligibility criteria (60 evaluated single interventions, 14 bundle/multimodal), addressing 13 of 25 research questions. The majority were conducted in high-income countries; 36 focused on neonates. Evidence was very uncertain for 11 of the 13 research questions. Stronger COE showed that ultrasound-guided catheter insertion reduced phlebitis/thrombophlebitis in adults compared with non-ultrasound-guided (5 RCTs; risk ratio [RR], 0.19; 95% credible interval, .08-.50); silicone catheters increased phlebitis/thrombophlebitis compared with nonsilicone (1 RCT; RR, 2.00; 95% confidence interval [CI], 1.26-3.17). Bundle interventions decreased local infections (1 RCT; RR, 0.47; 95% CI, .31-.72) and phlebitis/thrombophlebitis in adults (1 RCT; RR, 0.35; 95% CI, .22-.56) compared with routine care.

Conclusions: Ultrasound-guided catheter insertion and nonsilicone catheters effectively prevented PICC complications. The evidence for other comparisons was too uncertain to draw conclusions, highlighting the urgent need for additional studies on prevention and control interventions.

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预防外周血管感染和其他感染及非感染性并发症方法的有效性和安全性：一项系统综述和荟萃分析

背景：外周中心导管（PICCs）的并发症发生率为29%。本系统综述评估了25项干预措施，以预防picc相关的传染性和非传染性并发症，所有年龄的参与者。方法：检索电子数据库（MEDLINE, Embase, Cochrane Library, WHO Global Index Medicus， CINAHL）和参考文献列表，检索1980年1月1日至2024年5月8日发表的随机（rct）和非随机研究。我们双重选择研究，评估偏倚风险，提取数据，并评估证据确定性（COE）。我们既纳入了感兴趣的单一干预措施，也纳入了至少两种干预措施的组合（捆绑/多模式）。如果存在三个或更多的随机对照试验，我们进行贝叶斯随机效应荟萃分析。结果：74项研究符合我们的资格标准（60项单独干预，14项一揽子/多模式），解决了25个研究问题中的13个。大多数是在高收入国家进行的；36个重点关注新生儿。在13个研究问题中，有11个问题的证据非常不确定。具有更强COE的证据表明，与非超声引导置入相比，超声引导置入导管可减少成人静脉炎/血栓性静脉炎(5项rct；风险比[RR] 0.19, 95%可信区间0.08 ~ 0.50)；与非硅胶导管相比，硅胶导管增加了静脉炎/血栓性静脉炎（1项随机对照试验，RR 2.00, 95%可信区间[95% ci] 1.26-3.17）。与常规护理相比，捆绑干预减少了局部感染（1项RCT， RR 0.47, 95%CI 0.31-0.72）和成人静脉炎/血栓性静脉炎（1项RCT， RR 0.35, 95%CI 0.22-0.56）。结论：超声引导下置管及非硅胶置管可有效预防PICC并发症。其他比较的证据太不确定，无法得出结论，这突出表明迫切需要对预防和控制干预措施进行更多的研究。

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

Clinical Infectious Diseases 医学-传染病学

CiteScore

25.00

自引率

2.50%

发文量

900

审稿时长

3 months

期刊介绍： Clinical Infectious Diseases (CID) is dedicated to publishing original research, reviews, guidelines, and perspectives with the potential to reshape clinical practice, providing clinicians with valuable insights for patient care. CID comprehensively addresses the clinical presentation, diagnosis, treatment, and prevention of a wide spectrum of infectious diseases. The journal places a high priority on the assessment of current and innovative treatments, microbiology, immunology, and policies, ensuring relevance to patient care in its commitment to advancing the field of infectious diseases.