Risk of catheter‐related bloodstream infection associated with midline catheters compared with peripherally inserted central catheters: A meta‐analysis

Abstract

Background Both midline catheters (MCs) and peripherally inserted central catheters (PICCs) can cause catheter‐related bloodstream infection (CRBSI), but the prevalence associated with each is not clear. Objective To compare the risk of CRBSI between MCs and PICCs with a meta‐analysis. Methods The Web of Science Core Collection, PubMed, Scopus, Embase, The Cochrane Library and ProQuest were searched. All studies comparing the risk of CRBSI between MCs and PICCs were included. Selected studies were assessed for methodological quality using the Downs and Black checklist. Two authors independently assessed the literature and extracted the data. A fixed effects model was used to generate estimates of CRBSI risk in patients with MCs versus PICCs. Publication bias was evaluated, and meta‐analyses were conducted with RevMan 5.3. Results A total of 167 studies were identified. Ten studies were collected, involving 33,322 patients. The prevalence of CRBSI with MCs and PICCs was 0.58% (40/6,900) and 0.48% (127/26,422), respectively. Meta‐analysis showed that the prevalence of CRBSI was not significantly different between MCs and PICCs (RR = 0.77, 95% CI: 0.50–1.17, p = .22). While the result showed that the prevalence of CRBSI with MCs was lower than that with PICCs (RR = 0.55, 95% CI: 0.33–0.92, p = .02) after poor‐quality studies were removed. The sensitivity analysis shows that the results from this meta‐analysis are fair in overall studies and non‐poor‐quality studies. All studies have no significant publication bias. Conclusions This study provides the first systematic assessment of the risk of CRBSI between MCs and PICCs and provides evidence for the selection of appropriate vascular access devices for intravenous infusion therapy in nursing. The prevalence of CRBSI was not significantly different between them.

Comparing Complication Rates of Midline Catheter vs Peripherally Inserted Central Catheter. A Systematic Review and Meta-analysis

“…It is important to note that CLABSI rates being higher in PICCs is largely being driven by 1 cohort [ 32 ]. A prior meta-analysis by Lu and colleagues found no difference in rates of CRBSI between PICCs and midlines (relative risk, 0.77; 95% CI, 0.50–1.17) [ 5 ].…”

“…It is a shorter catheter inserted into the arm, like a PICC, but terminating at the basilic or axillary vein rather than the central venous circulation. These devices provide the benefit of durable access, but with shorter length and lower surface area, reducing the theoretical risk of thrombosis and contamination, as well as possibly lowering rates of infection [ 5 ]. Midline catheters have a shorter indwell time (up to 4 weeks) compared with PICC lines (weeks to months) but are considerably more durable than peripheral IVs.…”

Patterns, appropriateness and outcomes of peripherally inserted central catheter use in Brazil: a multicentre study of 12 725 catheters

“…Available evidence indicates that midlines can easily be placed at bedside and are reasonable when the expected intravenous duration of therapy is less than 14 days. However, use of midlines may be constrained by infusate pH and osmolarity restrictions which may necessitate use of a central venous catheter such as a PICC 32 33…”

Clinical effects of continuity of nursing care for peripherally inserted central catheters among discharged cancer patients: A systematic review of randomized controlled trials

“…Unfortunately, patients routinely require catheter retention after hospital discharge, and most cannot maintain their PICCs promptly and adequately [6]. Nevertheless, appropriate management of PICCs could signi cantly reduce local infections around the insertion site or catheter-related bloodstream infections, which may progress to systemic infections [7].…”