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Published on: July 13, 2019
Risk of catheter-related bloodstream infection associated with midline catheters compared with peripherally inserted
Huapeng Lu1, Yeru Hou2, Jiejie Chen2
1Department of Hepatobiliary and Pancreas Surgery, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, P. R. China.
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.
Insights
Midline catheters (MCs) and peripherally inserted central catheters (PICCs) have similar risks for catheter-related bloodstream infection (CRBSI). This meta-analysis found no significant difference in CRBSI prevalence between MCs and PICCs.
Area of Science:
- Medical Devices
- Infectious Diseases
- Clinical Research
Background:
- Catheter-related bloodstream infection (CRBSI) is a significant complication associated with vascular access devices.
- Both midline catheters (MCs) and peripherally inserted central catheters (PICCs) are used for intravenous therapy but their comparative risk for CRBSI is not well-established.
Purpose of the Study:
- To conduct a meta-analysis comparing the risk of CRBSI between MCs and PICCs.
- To provide evidence-based guidance for selecting appropriate vascular access devices in clinical practice.
Main Methods:
- A comprehensive literature search was performed across multiple databases (Web of Science, PubMed, Scopus, Embase, Cochrane Library, ProQuest).
- Studies comparing CRBSI risk between MCs and PICCs were included and assessed for quality using the Downs and Black checklist.
- A fixed-effects model was employed for meta-analysis, with publication bias evaluated.
Main Results:
- Ten studies involving 33,322 patients were analyzed. The overall prevalence of CRBSI was 0.58% for MCs and 0.48% for PICCs.
- The meta-analysis revealed no statistically significant difference in CRBSI risk between MCs and PICCs (RR = 0.77, 95% CI: 0.50-1.17, p = 0.22).
- However, after excluding poor-quality studies, MCs showed a significantly lower CRBSI prevalence than PICCs (RR = 0.55, 95% CI: 0.33-0.92, p = 0.02).
Conclusions:
- This meta-analysis is the first systematic assessment comparing CRBSI risk between MCs and PICCs.
- The overall prevalence of CRBSI was not significantly different between the two types of catheters.
- Further research may be needed to clarify the risk based on study quality, informing optimal device selection for intravenous therapy.
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