Hostname: page-component-8448b6f56d-42gr6 Total loading time: 0 Render date: 2024-04-20T12:37:19.129Z Has data issue: false hasContentIssue false
  • English
  • Français

The Risk of Bloodstream Infection Associated with Peripherally Inserted Central Catheters Compared with Central Venous Catheters in Adults: A Systematic Review and Meta-Analysis

Published online by Cambridge University Press:  02 January 2015

Vineet Chopra ,
John C. O'Horo ,
Mary A. M. Rogers ,
Dennis G. Maki  and
Nasia Safdar
Vineet Chopra
Affiliation:
Patient Safety Enhancement Program, Hospital Outcomes Program of Excellence and Center for Clinical Management Research, Ann Arbor Veterans Affairs Medical Center and, University of Michigan School of Medicine, Ann Arbor, Michigan
John C. O'Horo
Affiliation:
Division of Pulmonary and Critical Care Medicine, College of Medicine, Mayo Clinic, Rochester, Minnesota
Mary A. M. Rogers
Affiliation:
Patient Safety Enhancement Program, Hospital Outcomes Program of Excellence and Center for Clinical Management Research, Ann Arbor Veterans Affairs Medical Center and, University of Michigan School of Medicine, Ann Arbor, Michigan
Dennis G. Maki
Affiliation:
William S. Middleton Memorial Veterans Affairs Medical Center and Division of Infectious Diseases, Department of Medicine, University of Wisconsin Medical School and Infection Control Department, University of Wisconsin-Madison, Madison, Wisconsin
Nasia Safdar*
Affiliation:
William S. Middleton Memorial Veterans Affairs Medical Center and Division of Infectious Diseases, Department of Medicine, University of Wisconsin Medical School and Infection Control Department, University of Wisconsin-Madison, Madison, Wisconsin
*
5221, University of Wisconsin Hospital and Clinics, Madison, WI 53705 (ns2@medicine.wisc.edu)
Get access Rights & Permissions [Opens in a new window]

Abstract

Background.

Peripherally inserted central catheters (PICCs) are associated with central line-associated bloodstream infection (CLABSI). The magnitude of this risk relative to central venous catheters (CVCs) is unknown.

Objective.

To compare risk of CLABSI between PICCs and CVCs.

Methods

MEDLINE, CinAHL, Scopus, EmBASE, and Cochrane CENTRAL were searched. Full-text studies comparing the risk of CLABSI between PICCs and CVCs were included. Studies involving adults 18 years of age or older who underwent insertion of a PICC or a CVC and reported CLABSI were included in our analysis. Studies were evaluated using the Downs and Black scale for risk of bias. Random effects meta-analyses were used to generate summary estimates of CLABSI risk in patients with PICCs versus CVCs.

Results.

Of 1,185 studies identified, 23 studies involving 57,250 patients met eligibility criteria. Twenty of 23 eligible studies reported the total number of CLABSI episodes in patients with PICCs and CVCs. Pooled meta-analyses of these studies revealed that PICCs were associated with a lower risk of CLABSI than were CVCs (relative risk [RR], 0.62; 95% confidence interval [CI], 0.40-0.94). Statistical heterogeneity prompted subgroup analysis, which demonstrated that CLABSI reduction was greatest in outpatients (RR [95% CI], 0.22 [0.18-0.27]) compared with hospitalized patients who received PICCs (RR [95% CI], 0.73 [0.54-0.98]). Thirteen of the included 23 studies reported CLABSI per catheter-day. Within these studies, PICC-related CLABSI occurred as frequently as CLABSI from CVCs (incidence rate ratio [95% CI], 0.91 [0.46-1.79]).

Limitations.

Only 1 randomized trial met inclusion criteria. CLABSI definition and infection prevention strategies were variably reported. Few studies reported infections by catheter-days.

Conclusions.

Although PICCs are associated with a lower risk of CLABSI than CVCs in outpatients, hospitalized patients may be just as likely to experience CLABSI with PICCs as with CVCs. Consideration of risks and benefits before PICC use in inpatient settings is warranted.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 34 , Issue 9 , September 2013 , pp. 908 - 918
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2013

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.O'Grady, NP, Alexander, M, Dellinger, EP, et al.Guidelines for the prevention of intravascular catheter-related infections. Am J Infect Control 2002;30:476–489.Google Scholar
2.Mermel, LA, Farr, BM, Sherertz, RJ, et al.Guidelines for the management of intravascular catheter-related infections. Clin Infect LHs 2001;32:1249–1272.Google Scholar
3.Safdar, N, Maki, DG. Risk of catheter-related bloodstream infection with peripherally inserted central venous catheters used in hospitalized patients. Chest 2005;128:489–495.Google Scholar
4.Mermel, LA, Allon, M, Bouza, E, et al.Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis 2009;49:1–45.Google Scholar
5.Safdar, N. Bloodstream infection: an ounce of prevention is a ton of work. Infect Control Hosp Epidemiol 2005;26:511–514.Google ScholarPubMed
6.Pronovost, P, Needham, D, Berenholtz, S, et al.An intervention to decrease catheter-related bloodstream infections in the ICU. New Engl J Med 2006;355:2725–2732.CrossRefGoogle ScholarPubMed
7.Al Raiy, B, Fakih, MG, Bryan-Nomides, N, et al.Peripherally inserted central venous catheters in the acute care setting: a safe alternative to high-risk short-term central venous catheters. Am J Infect Control 2010;38:149–153.Google Scholar
8.Moureau, N, Poole, S, Murdock, MA, Gray, SM, Semba, CP. Central venous catheters in home infusion care: outcomes analysis in 50, 470 patients. J Vase Interv Radiol 2002;13:1009–1016.CrossRefGoogle Scholar
9.Gunst, M, Matsushima, K, Vanek, S, Gunst, R, Shaft, S, Frankel, H. Peripherally inserted central catheters may lower the incidence of catheter-related blood stream infections in patients in surgical intensive care units. Surg Infect (Larchmt) 2011;12:279–282.CrossRefGoogle ScholarPubMed
10.Cowl, CT, Weinstock, JV, Al-Jurf, A, Ephgrave, K, Murray, JA, Dillon, K. Complications and cost associated with parenteral nutrition delivered to hospitalized patients through either subclavian or peripherally-inserted central catheters. Clin Nutr 2000;19:237–243.CrossRefGoogle ScholarPubMed
11.Skaff, ER, Doucette, S, McDiarmid, S, Huebsch, L, Sabloff, M. Vascular access devices in leukemia: a retrospective review amongst patients treated at the Ottawa hospital with induction chemotherapy for acute leukemia. Leuk Lymphoma 2012;53: 1090–1095.CrossRefGoogle Scholar
12.Moher, D, Liberati, A, Tetzlaff, J, Altman, DG; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg 2010;8:336–341.CrossRefGoogle ScholarPubMed
13.Zhao, VM, Griffith, DP, Blumberg, HM, et al.Characterization of post-hospital infections in adults requiring home parenteral nutrition. Nutrition 2013;29:52–59.Google Scholar
14.Worth, LJ, Seymour, JF, Slavin, MA. Infective and thrombotic complications of central venous catheters in patients with hematological malignancy: prospective evaluation of nontunneled devices. Support Care Cancer 2009;17:811–818.CrossRefGoogle ScholarPubMed
15.Cheng, CE, Kroshinsky, D. Iatrogenic skin injury in hospitalized patients. Clin Dermatol 2011;29:622–632.Google Scholar
16.Downs, SH, Black, N. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Community Health 1998;52:377–384.Google Scholar
17.Sweeting, MJ, Sutton, AJ, Lambert, PC. What to add to nothing? Use and avoidance of continuity corrections in meta-analysis of sparse data. Stat Med 2004;23:1351–1375.Google Scholar
18.Higgins, JP, Thompson, SG, Deeks, JJ, Altman, DG. Measuring inconsistency in meta-analyses. BMJ 2003;327:557–560.CrossRefGoogle ScholarPubMed
19.Alhimyary, A, Fernandez, C, Picard, M, et al.Safety and efficacy of total parenteral nutrition delivered via a peripherally inserted central venous catheter. Nutr Clin Pract 1996;11:199–203.Google Scholar
20.Cortelezzia, A, Fracchiolla, NS, Maisonneuve, P, et al.Central venous catheter-related complications in patients with hematological malignancies: a retrospective analysis of risk factors and prophylactic measures. Leuk Lymphoma 2003;44:1495–1501.Google Scholar
21.Cotogni, P, Pittiruti, M, Barbero, C, Monge, T, Palmo, A, Boggio Bertinet, D. Catheter-related complications in cancer patients on home parenteral nutrition: a prospective study of over 51, 000 catheter days. JPEN J Parenter Enteral Nutr 2012;37:375–383.CrossRefGoogle Scholar
22.DeLegge, MH, Borak, G, Moore, N. Central venous access in the home parenteral nutrition population-you PICC. JPEN J Par-enter Enteral Nutr 2005;29:425–428.Google Scholar
23.Duerksen, DR, Papineau, N, Siemens, J, Yaffe, C. Peripherally inserted central catheters for parenteral nutrition: a comparison with centrally inserted catheters. JPEN J Parenter Enteral Nutr 1999;23:85–89.Google Scholar
24.Fearonce, G, Faraklas, I, Saffle, JR, Cochran, A. Peripherally inserted central venous catheters and central venous catheters in burn patients: a comparative review. J Burn Care Res 2010;31: 31–35.Google Scholar
25.Graham, DR, Keldermans, MM, Klemm, LW, Semenza, NJ, Shafer, ML. Infectious complications among patients receiving home intravenous therapy with peripheral, central, or peripherally placed central venous catheters. Am J Med 1991;91:95S–100S.Google Scholar
26.Griffiths, VR, Philpot, P. Peripherally inserted central catheters (PICCs): do they have a role in the care of the critically ill patient? Intensive Crit Care Nurs 2002;18:37–47.CrossRefGoogle ScholarPubMed
27.Lim, MY, Al-Kali, A, Ashrani, AA, et al.Comparison of complication rates of Hickman catheters versus peripherally-inserted central catheters in acute myeloid leukemia patients undergoing induction chemotherapy. Leuk Lymphoma 2012;2013:1263–1267.Google Scholar
28.Mollee, P, Jones, M, Stackelroth, J, et al.Catheter-associated bloodstream infection incidence and risk factors in adults with cancer: a prospective cohort study. J Hasp Infect 2011;78:26–30.Google Scholar
29.Paz-Fumagalli, R, Miller, YA, Russell, BA, Crain, MR, Beres, RA, Mewissen, MW. Impact of peripherally inserted central catheters on phlebitic complications of peripheral intravenous therapy in spinal cord injury patients. J Spinal Cord Med 1997;20:341–344.CrossRefGoogle ScholarPubMed
30.Raad, I, Umphrey, J, Khan, A, Truett, LJ, Bodey, GP. The duration of placement as a predictor of peripheral and pulmonary arterial catheter infections. J Hosp Infect 1993;23:17–26.Google Scholar
31.Schuman, E, Brady, A, Gross, G, Hayes, J. Vascular access options for outpatient cancer therapy. Am J Surg 1987;153:487–489.Google Scholar
32.Smith, JR, Friedell, ML, Cheatham, ML, Martin, SP, Cohen, MJ, Horowitz, JD. Peripherally inserted central catheters revisited. Am J Surg 1998;176:208–211.Google Scholar
33.Snelling, R, Jones, G, Figueredo, A, Major, P. Central venous catheters for infusion therapy in gastrointestinal cancer: a comparative study of tunnelled centrally placed catheters and peripherally inserted central catheters. J Intraven Nurs 2001;24:38–47.Google ScholarPubMed
34.Wilson, TJ, Brown, DL, Meurer, WJ, Stetler, WR Jr, Wilkinson, DA, Fletcher, JJ. Risk factors associated with peripherally inserted central venous catheter-related large vein thrombosis in neurological intensive care patients. Intensive Care Med 2012;38: 272–278.CrossRefGoogle ScholarPubMed
35.Worth, LJ, Seymour, JF, Slavin, MA. Infective and thrombotic complications of central venous catheters in patients with hematological malignancy: prospective evaluation of nontunneled devices. Support Care Cancer 2009;17:811–818.Google Scholar
36.Skaff, ER, Doucette, S, McDiarmid, S, Huebsch, L, Sabloff, M. Vascular access devices in leukemia: a retrospective review amongst patients treated at the Ottawa Hospital with induction chemotherapy for acute leukemia. Leuk Lymphoma 2012;53: 1090–1095.CrossRefGoogle Scholar
37.Mollee, P, Jones, M, Stackelroth, J, et al.Catheter-associated bloodstream infection incidence and risk factors in adults with cancer: a prospective cohort study. J Hosp Infect 2011;78:26–30.Google Scholar
38.Gunst, M, Matsushima, K, Vanek, S, Gunst, R, Shafi, S, Frankel, H. Peripherally inserted central catheters may lower the incidence of catheter-related blood stream infections in patients in surgical intensive care units. Surg Infect (Larchmt) 2011;12:279–282.CrossRefGoogle ScholarPubMed
39.Fearonce, G, Faraklas, I, Saffle, JR, Cochran, A. Peripherally inserted central venous catheters and central venous catheters in burn patients: a comparative review. J Burn Care Res 2010;31: 31–35.CrossRefGoogle ScholarPubMed
40.Cortelezzia, A, Fracchiolla, NS, Maisonneuve, P, et al.Central venous catheter-related complications in patients with hematological malignancies: a retrospective analysis of risk factors and prophylactic measures. Leuk Lymphoma 2003;44:1495–1501.Google Scholar
41.Graham, DR, Keldermans, MM, Klemm, LW, Semenza, NJ, Shafer, ML. Infectious complications among patients receiving home intravenous therapy with peripheral, central, or peripherally placed central venous catheters. Am J Med 1991;91:95S–100S.CrossRefGoogle ScholarPubMed
42.Marsteller, JA, Sexton, JB, Hsu, YJ, et al.A multicenter, phased, cluster-randomized controlled trial to reduce central lineassociated bloodstream infections in intensive care units. Crit Care Med 2012;40:2933–2939.Google Scholar
43.Centers for Disease Control and Prevention. Vital signs: central line-associated blood stream infections—United States, 2001, 2008, and 2009. MMWR Morb Mortal Wkly Rep 2011;60:243–248.Google Scholar
44.Kuehn, BM. Hospitals slash central line infections with program that empowers nurses. JAMA 2012;308:1617–1618.Google Scholar
45.Lin, DM, Weeks, K, Bauer, L, et al.Eradicating central line-associated bloodstream infections statewide: the Hawaii experience. Am J Med Qual 2012;27:124–129.Google Scholar
46.Schulman, J, Stricof, R, Stevens, TP, et al.Statewide NICU central-line-associated bloodstream infection rates decline after bundles and checklists. Pediatrics 2011;127:436–444.Google Scholar
47.Maki, DG, Kluger, DM, Crnich, CJ. The risk of bloodstream infection in adults with different intravascular devices: a systematic review of 200 published prospective studies. Mayo Clin Proc 2006;81:1159–1171.CrossRefGoogle ScholarPubMed
48.Chopra, V, Anand, S, Krein, SL, Chenoweth, C, Saint, S. Bloodstream infection, venous thrombosis, and peripherally inserted central catheters: reappraising the evidence. Am J Med 2012;125:733–741.Google Scholar
49.Climo, M, Diekema, D, Warren, DK, et al.Prevalence of the use of central venous access devices within and outside of the intensive care unit: results of a survey among hospitals in the Prevention Epicenter Program of the Centers for Disease Control and Prevention. Infect Control Hosp Epidemiol 2003;24:942–945.Google Scholar
50.Zingg, W, Sandoz, L, Inan, C, et al.Hospital-wide survey of the use of central venous catheters. J Hosp Infect 2011;77:304–308.Google Scholar
51.Advani, S, Reich, NG, Sengupta, A, Gosey, L, Milstone, AM. Central line-associated bloodstream infection in hospitalized children with peripherally inserted central venous catheters: extending risk analyses outside the intensive care unit. Clin Infect Dis 2011; 52:1108–1115.CrossRefGoogle ScholarPubMed
52.Safdar, N, Maki, DG. The pathogenesis of catheter-related bloodstream infection with noncuffed short-term central venous catheters. Intensive Care Med 2004;30:62–67.CrossRefGoogle ScholarPubMed
53.Mermel, LA. What is the predominant source of intravascular catheter infections? Clin Infect Dis 2011;52:211–212.Google Scholar
54.McCoy, M, Bedwell, S, Noori, S. Exchange of peripherally inserted central catheters is associated with an increased risk for bloodstream infection. Am J Perinatol 2011;28:419–424.Google Scholar
55.Chopra, V, Anand, S, Krein, SL, Chenoweth, C, Saint, S. Bloodstream infection, venous thrombosis, and peripherally inserted central catheters: reappraising the evidence. Am J Med 2012;125: 733–741.Google Scholar
56.Tejedor, SC, Tong, D, Stein, J, et al.Temporary central venous catheter utilization patterns in a large tertiary care center: tracking the “idle central venous catheter.” Infect Control Hosp Epidemiol 2012;33:50–57.CrossRefGoogle Scholar
57.O'Grady, NP, Alexander, M, Burns, LA, et al.Guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis 2011;52:e162–e193.Google Scholar