Comparison of complication rates between midline catheters and peripherally inserted central catheters: a systematic review and meta-analysis of randomized controlled trials

Abstract

BackgroundMidline catheters (MCs) and peripherally inserted central catheters (PICCs) are essential for reliable vascular access in patients. Despite their prevalent use, comparative risk assessments of these catheters, particularly from randomized controlled trials (RCTs), remain scarce. This meta-analysis primarily focuses on RCTs to evaluate and compare the incidence of complications associated with MCs and PICCs. MethodsWe conducted a comprehensive search of databases including the Cochrane Library, PubMed, Embase, Web of Science, ScienceDirect, Scopus, and ProQuest, up to April 2024. The primary outcomes analyzed were total complications and catheter-related bloodstream infections (CRBSIs), while secondary outcomes included catheter dwell time and thrombosis incidence. Meta-analyses were performed using a random-effects model. ResultsFrom 831 initially identified articles, 5 trials involving 608 patients met the inclusion criteria. MCs exhibited a significantly higher rate of total complications compared to PICCs (relative risk = 1.95, 95% confidence interval = 1.23–3.08, p = 0.005, I2= 0%). MCs also had shorter dwell times and a higher incidence of premature removal. However, no significant differences were observed in the rates of CRBSIs or thrombosis between MCs and PICCs. ConclusionsPICCs are associated with fewer total complications and longer dwell times compared to MCs, which tend to be more often removed prematurely. Thrombosis rates were similar between the two catheter types, underscoring the need for careful catheter selection based on specific patient conditions and treatment duration. Further research, particularly additional randomized controlled trials, is necessary to confirm these findings and guide optimal catheter selection in clinical practice.