Tunneled Peripherally Inserted Central Catheters and Bloodstream Infection: A Systematic Review and Meta-Analysis.

Area of Science:

• Infection Control
• Medical Devices
• Clinical Epidemiology

Background:

• Central line-associated bloodstream infections (CLABSI) are a significant concern in hospitalized patients.
• Peripherally inserted central catheters (PICCs) are widely used, but carry infection risks.
• Different insertion techniques, such as tunneled vs. conventional, may impact CLABSI rates.

Purpose of the Study:

• To compare central line-associated bloodstream infection (CLABSI) rates between tunneled peripherally inserted central catheters (tPICCs) and conventionally inserted PICCs (cPICCs).

Main Methods:

• A systematic review and meta-analysis of randomized controlled trials was conducted.
• Searches were performed in PubMed, Embase, and Cochrane Library up to November 27, 2024.
• Data were analyzed using a random-effects model to calculate risk ratios and assess heterogeneity.

Main Results:

• The meta-analysis included four studies with 2,659 participants and 177,879 catheter days.
• CLABSI rates were 0.31 per 1,000 catheter-days for tPICCs versus 0.68 per 1,000 catheter-days for cPICCs.
• A 52% reduction in CLABSI was observed for tPICCs (Risk Ratio: 0.48; 95% CI, 0.28-0.81; p=0.02) with low heterogeneity.

Conclusions:

• Subcutaneous tunneling for PICC placement is associated with a significant reduction in CLABSI rates.
• This technique may enhance patient safety for hospitalized adults requiring central venous access.
• Tunneled PICCs represent a potentially safer alternative to conventional PICCs for reducing bloodstream infections.