Evaluation on effectiveness and safety of peripherally inserted central catheters technology

Abstract

Background: The use of peripherally inserted central catheters (PICC) in medical practice has increased rapidly over the last decades. PICC provides venous access for patients requiring prolonged therapy and infusion of caustic solutions. Despite of these benefits, PICC, as an invasive technology, is associated with many complications. Studies reported that the incidence of PICC-related complication ranged from 25% to 50%. It is known that PICC is more effective and safe than other prolonged venous infusion technologies including central venous catheters (CVC) and venous port access (VPA). So professionals need to compare the effectiveness and safety between PICC, CVC and VPA when they provide venous access for patients. Objective: To overview the systematic review/meta-analysis of effectiveness and safety of peripherally inserted central catheters technology. Methods: PICO-D was adopted to identify the search strategy. Patients (P) included participants with venous access of PICC, CVC or VPA, and older than 18 years. Interventions (I) referred to PICC and compares referred to CVC or VPA. The outcomes of effectiveness were insertion success rate and dwelling time. The outcomes of safety were incidence of complications (catheter-related infection, catheter-related venous thrombosis, phlebitis, occlusion, and so on) during insertion and maintenance. Databases including the Cochrane Library (issue 10, 2015), Medline, EMBASE, CNKI, CMB, WANFANG and VIP from inception to October, 2015. Literature screening and appraisal, data extracting were done by two reviewers. AMSTAR tool and GRADE system were used to assess the methodological quality of included literatures and quality of evidence according to outcomes. Results: 15 articles met the inclusion criteria. 13 articles were published after 2010. 14 articles assessed the methodological quality of included studies, and 8 systematic reviews adopted Cochrane bias risk assessment tool. The results of AMSTAR assessment showed that only 6 systematic reviews were high quality and the most defects were as following: not providing a SR protocol, not including unpublished literatures, not listing included and excluded studies and not stating conflict of interest. The results of quality of evidence assessment for 17 outcomes from systematic reviews suggested that the quality of evidence of 6 outcomes were middle, and others were low or very low. Discussion/Conclusion: The methodological quality of included literatures is not high and the quality of evidence of outcomes is most low. As a whole, there is not enough evidence to support that PICC is more effective than CVC and VPA. The risk of complications for PICC is lower than CVC and VPA during insertion. But the risk of complications for PICC is higher than CVC and VPA during maintaining. Due to limitation of quality and quantity of included systematic reviews, the conclusions need more high quality studies to support.