Peripherally inserted central catheter–related thrombosis rate in modern vascular access era—when insertion technique matters: A systematic review and meta-analysis

Abstract

Background: Technical factors at the moment of catheter insertion might have a role in peripherally inserted central catheter–related thrombotic risk. We performed a systematic review and meta-analysis to define the actual rate of peripherally inserted central catheter–related symptomatic deep vein thrombosis in patients in whom catheter insertion was performed according to ultrasound guidance, appropriate catheter size choice, and proper verification of tip location. Methods: We searched Medline, Embase, and Cochrane Library. Only prospective observational studies published in peer-reviewed journals after 2010 up to November 2018 reporting peripherally inserted central catheter–related deep vein thrombosis rate were included. All studies were of adult patients who underwent peripherally inserted central catheter insertion. Results were restricted to those studies which included in their methods ultrasound guidance for venipuncture, catheter tip location, and a catheter size selection strategy. Random-effect meta-analyses and arcsine transformation for binomial data were performed to pool deep vein thrombosis weighted frequencies. Results: Of the 1441 studies identified, 15 studies involving 5420 patients and 5914 peripherally inserted central catheters fulfilled our inclusion criteria. The weighted frequency of peripherally inserted central catheter–related deep vein thrombosis was 2.4% (95% confidence interval = 1.5–3.3) and remained low in oncologic patients (2.2%, 95% confidence interval = 0.6–3.9). Thrombotic rate was higher in onco-hematologic patients (5.9%, 95% confidence interval = 1.2–10). Considerable heterogeneity (I2 = 74.9) was observed and all studies were considered at high risk of attrition bias. Conclusions: A proper technique is crucial at the moment of peripherally inserted central catheter insertion. Peripherally inserted central catheter–related deep vein thrombosis rate appears to be low when evidence-based technical factors are taken into consideration during the insertion procedure.

Evaluating the Impact of Central Venous Catheter Materials and Design on Thrombosis: A Systematic Review and Meta‐Analysis

“…This systematic review and meta‐analysis investigated thrombosis rates across recently published trials examining antithrombogenic catheter materials and designs. Due to changes in clinical practice and products in recent years, thrombosis rates have reportedly declined (Balsorano et al, 2019; Smith et al, 2017); however, complications persist, and given the associated financial and clinical burden these pose, a review of research in this area was essential to provide clarity on the effectiveness of these interventions to clinicians and decision‐makers. The results of this review indicate that there was no significant difference between thrombosis rates in patients receiving standard CVC and PICC devices, devices coated or impregnated with antithrombogenic materials, or devices with designs aimed at reducing thrombosis.…”

Vascular access in COVID-19 patients: Smart decisions for maximal safety

“…6,7 The risk of thrombosis and infection is similar to CICCs and—for both devices—depends mainly on the insertion technique. 8 Though, in COVID patients, PICC may have some specific advantages: its insertion and management is more compatible with an optimal respiratory care (particularly in the patient who wears non-invasive ventilation devices, or has a tracheostomy, or needs periodical pronation); also the site of insertion of PICC at midarm moves the operator far from the mouth and nose of the patient, hopefully reducing the risk of airborne contamination.…”

Reconsidering the GAVeCeLT Consensus on catheter-related thrombosis, 13 years later

“…34 In fact, CRT rates have been steadily decreasing over the years, thanks to the adoption of appropriate strategies, such as ultrasound guidance, proper selection of vein and catheter size, adequate tip placement, and adequate catheter securement. 8,23 Understanding the clinical relevance of CRT is another key challenge today. Since the natural history of symptomatic CRT is well-known, we can intervene with prompt diagnosis and effective treatment and ensure a positive clinical outcome.…”