The incidence and risk of venous thromboembolism associated with peripherally inserted central venous catheters in hospitalized patients: A systematic review and meta-analysis

Abstract

BackgroundVenous thromboembolism (VTE) can be fatal if not treated promptly, and individual studies have reported wide variability in rates of VTE associated with peripherally inserted central catheters (PICC). We thus conducted this meta-analysis to investigate the overall incidence and risk of developing PICC-related VTE in hospitalized patients.MethodsWe searched PubMed, Embase, Scopus, and Web of Science databases from inception until January 26, 2022. In studies with a non-comparison arm, the pooled incidence of PICC-related VTE was calculated. The pooled odds ratio (OR) was calculated to assess the risk of VTE in the studies that compared PICC to the central venous catheter (CVC). The Newcastle-Ottawa Scale was used to assess methodological quality.ResultsA total of 75 articles (58 without a comparison arm and 17 with), including 109292 patients, were included in the meta-analysis. The overall pooled incidence of symptomatic VTE was 3.7% (95% CI: 3.1–4.4) in non-comparative studies. In the subgroup meta-analysis, the incidence of VTE was highest in patients who were in a critical care setting (10.6%; 95% CI: 5.0–17.7). Meta-analysis of comparative studies revealed that PICC was associated with a statistically significant increase in the odds of VTE events compared with CVC (OR, 2.48; 95% CI, 1.83–3.37; P < 0.01). However, in subgroup analysis stratified by the study design, there was no significant difference in VTE events between the PICC and CVC in randomized controlled trials (OR, 2.28; 95% CI, 0.77–6.74; P = 0.13).ConclusionBest practice standards such as PICC tip verification and VTE prophylaxis can help reduce the incidence and risk of PICC-related VTE. The risk-benefit of inserting PICC should be carefully weighed, especially in critically ill patients. Cautious interpretation of our results is important owing to substantial heterogeneity among the studies included in this study.

Published trends and research hotspots of central venous catheter-associated thrombosis from 1973 to 2022: A scientometric analysis

“…It is estimated that approximately one million ports are implanted each year worldwide. [52,65] Although PICCs have a higher risk of CVC-RT in critically ill or cancer patients than other types of CVCs, [7] they can be inserted by specially trained nurses at the patient bedside, which makes their use more convenient and accessible in settings that may significantly facilitate their utilization in clinical practice. [65][66][67] This could also explain why PICCs emerged as a research hotspot.…”

“…[1,2] However, all types of CVCs can inevitably cause catheter-related complications, such as bloodstream infection (BSI), thrombosis, phlebitis, and infiltration, [3–5] of which thrombosis is one of the most severe and common complications about which clinical staff are most concerned. [5–7]…”

“…[1,2] However, all types of CVCs can inevitably cause catheter-related complications, such as bloodstream infection (BSI), thrombosis, phlebitis, and infiltration, [3][4][5] of which thrombosis is one of the most severe and common complications about which clinical staff are most concerned. [5][6][7] CVCs can cause not only catheter-related thrombosis, which is generally defined as a mural thrombus extending from the catheter into the lumen of a vessel and resulting in partial or total catheter occlusion with or without symptoms [8] but also deep vein thrombosis (DVT) and pulmonary embolism, [9][10][11][12][13] indicating that CVC-related thrombosis (CVC-RT) is a potential life-threatening complication. The reported incidence of CVC-RT (including both symptomatic and asymptomatic CVC-RT) has varied significantly from 0.3% to 75% due to the differences in the definition of CVC-RT, study populations, CVC subtypes, study designs, precision of the diagnostic test used to detect CVC-RT, and other factors.…”

“…[16] CVC-RT was first reported in 1973, and a large number of studies on CVC-RT have been published at this point. Studies on CVC-RT have been carried out at all ages from infants to older adults [4,7,[17][18][19] and in different clinical settings, especially in oncology departments. [8,[20][21][22][23] Currently, insertion of CVCs has become a common practice in the oncology hematology department for systemic therapy.…”

The incidence and risk of different indwelling times of peripherally inserted central catheter-related venous thrombosis in cancer patients: a retrospective analysis of 654 patients

“…Long-term indwelling PICCs are prone to slow blood ow to the upper extremities on the catheter side, which predisposes patients to PICC-related venous thrombosis (PICC-RVT) [4]. Studies have con rmed that cancer patients exhibit a hypercoagulable state, and the incidence of PICC-RVT is 2%~75% [5][6][7].…”