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A Protocol to Set Up Needle-Free Connector with Positive Displacement on Central Venous Catheter in Intensive Care Unit
Published on: July 13, 2019
Effectiveness and Safety of Methods to Prevent Bloodstream and Other Infections and Noninfectious Complications
Andreea Dobrescu1, Alexandru Marian Constantin2, Larisa Pinte2
1Cochrane Austria, Department for Evidence-based Medicine and Evaluation, University for Continuing Education Krems, Krems, Austria.
Insights
Ultrasound-guided insertion and nonsilicone catheters effectively prevent peripherally inserted central catheter (PICC) complications. More research is needed for other interventions due to uncertain evidence.
Area of Science:
- Medical Interventions
- Patient Safety
- Clinical Practice Guidelines
Background:
- Peripherally inserted central catheters (PICCs) are associated with a significant 29% complication rate.
- Complications include both infectious and noninfectious adverse events.
- A comprehensive review of interventions is crucial for improving patient outcomes.
Purpose of the Study:
- To systematically review 25 interventions aimed at preventing complications associated with PICCs.
- To assess the efficacy of individual and combined (bundle/multimodal) interventions.
- To evaluate evidence certainty for various prevention strategies across all age groups.
Main Methods:
- Systematic search of major electronic databases (MEDLINE, Embase, Cochrane, CINAHL, WHO) and reference lists.
- Inclusion of randomized controlled trials (RCTs) and nonrandomized studies published from 1980 to 2024.
- Dual study selection, risk of bias assessment, data extraction, and certainty of evidence (COE) rating, with Bayesian meta-analyses for sufficient RCTs.
Main Results:
- Seventy-four studies evaluated 13 of 25 research questions, with most originating from high-income countries and many focusing on neonates.
- Evidence for 11 of 13 questions had very uncertain COE.
- Stronger evidence indicated ultrasound-guided insertion reduced phlebitis/thrombophlebitis (RR 0.19) and nonsilicone catheters increased it (RR 2.00) in adults. Bundle interventions decreased local infections (RR 0.47) and phlebitis/thrombophlebitis (RR 0.35) in adults.
Conclusions:
- Ultrasound-guided insertion and the use of nonsilicone catheters are effective in preventing PICC-related complications.
- Evidence for other interventions remains too uncertain to support definitive conclusions.
- There is an urgent need for further research into PICC prevention and control strategies.
Background:
Peripherally inserted central catheters (PICCs) have a 29% complication rate. This systematic review evaluated 25 interventions to prevent PICC-associated infectious and noninfectious complications in participants of all ages.
Methods:
We searched electronic databases (MEDLINE, Embase, Cochrane Library, World Health Organization Global Index Medicus, CINAHL) and reference lists for randomized (RCTs) and nonrandomized controlled trials published between 1 January 1980-8 May 2024. We dually selected studies, assessed risk of bias, extracted data, and rated certainty of evidence (COE). We included single interventions of interest and combinations of at least 2 (bundle/multimodal). If 3 or more RCTs existed, we conducted Bayesian random-effects meta-analyses.
Results:
Seventy-four studies met our eligibility criteria (60 evaluated single interventions, 14 bundle/multimodal), addressing 13 of 25 research questions. The majority were conducted in high-income countries; 36 focused on neonates. Evidence was very uncertain for 11 of the 13 research questions. Stronger COE showed that ultrasound-guided catheter insertion reduced phlebitis/thrombophlebitis in adults compared with non-ultrasound-guided (5 RCTs; risk ratio [RR], 0.19; 95% credible interval, .08-.50); silicone catheters increased phlebitis/thrombophlebitis compared with nonsilicone (1 RCT; RR, 2.00; 95% confidence interval [CI], 1.26-3.17). Bundle interventions decreased local infections (1 RCT; RR, 0.47; 95% CI, .31-.72) and phlebitis/thrombophlebitis in adults (1 RCT; RR, 0.35; 95% CI, .22-.56) compared with routine care.
Conclusions:
Ultrasound-guided catheter insertion and nonsilicone catheters effectively prevented PICC complications. The evidence for other comparisons was too uncertain to draw conclusions, highlighting the urgent need for additional studies on prevention and control interventions.
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