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. 2022 Jul 26:9:917572.
doi: 10.3389/fcvm.2022.917572. eCollection 2022.

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

Anju Puri  1 , Haiyun Dai  2 , Mohan Giri  2 , Chengfei Wu  1 , Huanhuan Huang  1 , Qinghua Zhao  1
Affiliations

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

Anju Puri et al. Front Cardiovasc Med. .

Abstract

Background: Venous 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.

Methods: We 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.

Results: A 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).

Conclusion: Best 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.

Keywords: central venous catheters; deep vein thrombosis; meta-analysis; peripherally inserted central catheters; pulmonary embolism; venous thromboembolism.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
PRISMA flow chart of the study selection process.
FIGURE 2
FIGURE 2
Forest plot showing the pooled incidence of PICC-related VTE among hospitalized patients in non-comparative studies. PICC, peripherally inserted central catheter; VTE, venous thromboembolism.
FIGURE 3
FIGURE 3
Leave-one-out sensitivity analysis of the pooled incidence of PICC-related VTE among hospitalized patients. PICC, peripherally inserted central catheter; VTE, venous thromboembolism.
FIGURE 4
FIGURE 4
Forest plot depicting the risk of VTE between the peripherally inserted central catheter and central venous catheters in studies with a comparison arm. PICC, peripherally inserted central catheter; CVC, central venous catheter.
FIGURE 5
FIGURE 5
Leave-one-out sensitivity analysis of the risk of VTE between the peripherally inserted central catheter and central venous catheters in studies with a comparison arm. VTE, venous thromboembolism; PICC, peripherally inserted central catheter; CVC, central venous catheter.
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References

    1. Jonczyk M, Gebauer B, Schnapauff D, Rotzinger R, Hamm B, Collettini F. Peripherally inserted central catheters: dependency of radiation exposure from puncture site and level of training. Acta Radiol. (2018) 59:688–93. 10.1177/0284185117730101 - DOI - PubMed
    1. Mielke D, Wittig A, Teichgräber U. Peripherally inserted central venous catheter (PICC) in outpatient and inpatient oncological treatment. Support Care Cancer. (2020) 28:4753–60. 10.1007/s00520-019-05276-0 - DOI - PMC - PubMed
    1. Johansson E, Hammarskjöld F, Lundberg D, Arnlind MH. Advantages and disadvantages of peripherally inserted central venous catheters (PICC) compared to other central venous lines: a systematic review of the literature. Acta Oncol. (2013) 52:886–92. 10.3109/0284186X.2013.773072 - DOI - PubMed
    1. Wang K, Zhong J, Huang N, Zhou Y. Economic evaluation of peripherally inserted central catheter and other venous access devices: a scoping review. J Vasc Access. (2020) 21:826–37. 10.1177/1129729819895737 - DOI - PubMed
    1. McDiarmid S, Scrivens N, Carrier M, Sabri E, Toye B, Huebsch L, et al. Outcomes in a nurse-led peripherally inserted central catheter program: a retrospective cohort study. CMAJ Open. (2017) 5:E535–9. 10.9778/cmajo.20170010 - DOI - PMC - PubMed

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