Photo Credit: Asikkk
Ultrasound-guided catheter insertion and nonsilicone catheters are associated with a lower risk for complications with peripherally inserted central catheters (PICCs), according to results from a systematic review and meta-analysis published in Clinical Infectious Diseases.
“Preferred over central catheters due to their easy insertion, short procedure time, reliable intravenous access, and high patient satisfaction rate, more than 2.5 million people receive PICCs annually,” Andreea Dobrescu, PhD, and colleagues wrote. “Despite their versatility and widespread use, PICCs are associated with complications—both infectious and noninfectious—in 8% to 30% of cases.”
The researchers assessed links between various interventions and PICC-associated complications across 74 studies. Most studies (n=60) addressed individual interventions, while 14 addressed bundle/multimodal interventions.
Catheter Types & Intervention Approaches
Of 25 preplanned research questions regarding PICC insertion, maintenance, access, and removal, the studies addressed 13. Of those 13 questions, evidence was “very uncertain” for 11.
Regarding findings with the strongest certainty of evidence, researchers reported that ultrasound-guided catheter insertion reduced the incidence of phlebitis/thrombophlebitis in adults compared with non-ultrasound-guided insertion. A meta-analysis of five randomized controlled trials identified a risk ratio of 0.19 for ultrasound-guided insertion.
Additionally, silicone catheters were associated with increased incidence of phlebitis/thrombophlebitis compared with nonsilicone catheters. A single randomized controlled trial reported a risk ratio of 2.00 with silicone catheters.
Analysis of the 14 studies that evaluated various intervention combinations found a lower incidence of local infections (risk ratio of 0.47) and phlebitis/thrombophlebitis (risk ratio of 0.35) with a bundle intervention, including sterile insertion, sterile gloves, ultrasound-guided insertion, lower arm insertion, silicone catheter, and occlusive dressing compared with routine care.
Need for Future Research
In all, however, the review identified a lack of evidence regarding interventions to prevent PICC complications, as well as methodological limitations in the available studies.
“Given the widespread PICC use in clinical practice and the concerning high rates of associated complications, a compelling argument exists to expand the research in this area,” Dr. Dobrescu and colleagues wrote. “Finally, given the limited evidence, health care providers and policymakers should also consider clinical experience, resource availability, and patient values and preferences to make informed decisions that better address patients’ needs and circumstances.”
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