Comparing Complication Rates of Midline Catheter vs Peripherally Inserted Central Catheter. A Systematic Review and Meta-analysis

Comparison of complication types in patients receiving vesicant intravenous antimicrobials or vasopressors via midlines and peripherally inserted central catheters

We assessed adverse events in hospitalized patients receiving selected vesicant antibiotics or vasopressors administered through midline catheters or peripherally inserted central catheters (PICC). The rates of catheter-related bloodstream infections, thrombosis, and overall events were similar across the two groups, while occlusion was higher in the PICC group.

Comparison of complications and indwelling time in midline catheters versus central venous catheters: A systematic review and meta-analysis

BACKGROUND

Central venous catheters and midline catheters are commonly used as medium- to long-term intravenous infusion tools in clinical nursing. However, there is currently no reliable conclusion on whether there are differences in complications and indwelling time between these two types of catheters.

AIM

To investigate whether there are differences in the incidence of complications and indwelling time between the use of midline catheters and central venous catheters as intravenous infusion tools.

METHODS

A systematic search was conducted across various databases including Web of Science, PubMed, Embase, Cochrane Library, CINAHL, Wanfang and China National Knowledge Infrastructure. The selection of studies and assessment of their quality was carried out independently by two reviewers. Meta-analysis was conducted using the RevMan 5.3 software. Heterogeneity was evaluated, one of the pooled analyses was performed using the random-effect model, while the others used the fixed-effect model. Mean differences or odds ratios with corresponding 95% confidence intervals were calculated.

RESULTS

Ten studies (1,554 participants) met the inclusion criteria. Meta-analysis showed that there was a statistically significant difference in the complication rates [OR = 0.36, 95% CI (0.18, 0.70), p = 0.003], incidence of catheter-related thrombosis [OR = 0.28, 95% CI (0.11, 0.71), I2 = 0%,p = 0.007], catheter-related infection[OR = 0.36, 95% CI (0.16, 0.78), I2 = 27%, p = 0.007] and catheter blockage [OR = 0.21, 95% CI (0.09, 0.51), I2 = 18%, p = 0.0005] between midline catheters group and central venous catheters group. There was a statistically significant difference in the catheter indwelling time between the two groups [MD = 0.9, 95% CI (0.33, 1.46), I2 = 0%, p = 0.002]. There was no significant difference in other complications such as phlebitis, catheter dislodgement and leakage between the two groups.

LINKING EVIDENCE TO ACTION

Midline catheter was superior to central venous catheter in terms of the overall complication rates and incidence of catheter-related thrombosis, catheter blockage, catheter-related infection and indwelling time.

Epidemiology and Clinical Insights of Catheter-Related Candidemia in Non-ICU Patients with Vascular Access Devices

INTRODUCTION

Vascular access devices (VADs), namely peripheral VADs (PVADs) and central venous VADs (CVADs), are crucial in both intensive care unit (ICU) and non-ICU settings. However, VAD placement carries risks, notably catheter-related bloodstream infections (CRBSIs). Candida spp. is a common pathogen in CRBSIs, yet its clinical and microbiological characteristics, especially in non-ICU settings, are underexplored.

METHODS

We conducted a monocentric, retrospective observational study at Luigi Sacco Hospital from 1 May 2021 to 1 September 2023. We reviewed medical records of non-ICU adult patients with CVADs and PVADs. Data on demographics, clinical and laboratory results, VAD placement, and CRBSI occurrences were collected. Statistical analysis compared Candida spp. CRBSI and bacterial CRBSI groups.

RESULTS

Out of 1802 VAD placements in 1518 patients, 54 cases of CRBSI were identified, and Candida spp. was isolated in 30.9% of episodes. The prevalence of CRBSI was 3.05%, with Candida spp. accounting for 0.94%. Incidence rates were 2.35 per 1000 catheter days for CRBSI, with Candida albicans and Candida non-albicans at 0.47 and 0.26 per 1000 catheter days, respectively-patients with Candida spp. CRBSI had more frequent SARS-CoV-2 infection, COVID-19 pneumonia, and hypoalbuminemia.

CONCLUSIONS

During the COVID-19 pandemic, Candida spp. was a notable cause of CRBSIs in our center, underscoring the importance of considering Candida spp. in suspected CRBSI cases, including those in non-ICU settings and in those with PVADs.

Long-term intravenous devices: a narrative review of their placement

PURPOSE OF REVIEW

This review summarizes the latest findings and recommendations about the characteristics, indications and use of peripheral and central long-term venous access devices.The various complications inherent in these devices are becoming better known, and their contributing factors determined, which could make it possible to reduce their incidence.

RECENT FINDINGS

Some measures are integrated into recommendations for good practice, such as appropriate selection of devices, the preferential use of the thinnest catheters, and cyanoacrylate glue and dressings impregnated with chlorhexidine.

SUMMARY

Improving understanding of the phenomena leading to infectious and thrombotic complications, as well as better knowing the differences between intravenous devices and their respective indications, should lead to improvement of in-hospital and out-of-hospital care.

Remote Assisted Home Dressing vs. Outpatient Medication of Central Venous Catheter (Peripherally Inserted Central Venous Catheter): Clinical Trial A.R.C.O. (Remote Assistance Oncology Caregiver)

BACKGROUND

Management of PICC dressing can be performed at home by the patient through adequate training and telenursing. This trial verifies that the incidence of catheter-related complications in home patients, assisted by telenursing, is not greater than that observed in outpatients.

METHODS

This clinical trial is composed of 72 patients with malignant tumors who underwent long-term chemotherapy with PICC insertion. They were randomly divided into an experimental group (33 cases) and a calibration group (39 cases). The control group received outpatient dressing for the PICC at the hospital, while the experimental group received a telenursing intervention about the management of the PICC. The incidence of catheter-related infections, the ability of self-management, and a rough cost/benefit estimation were compared between the two groups. This trial was performed according to the CONSORT 2010 checklist.

RESULTS

The two groups do not significantly differ in relation to age, sex, and PICCs in terms of the body side insertion, the type of dressing, and the agents used for cleaning. The analysis of the results showed that in the home-managed group, the clinical events reported during the connection were higher when compared with the outpatient group (p < 0.001). The patients in the homecare group developed frequent complications resulting from skin redness (p < 0.001).

CONCLUSION

The use of telenursing for patient education in cancer centers can reduce nurses' working time, improving the self-management capacity of patients with a long-term PICC. This trial was retrospectively registered with the Clinical Trial Gov on the 18 May 2023 with registration number NCT05880420.

Complications after peripherally inserted central catheter versus central venous catheter implantation in intensive care unit: propensity score analysis using a nationwide database

BACKGROUND

It remains unclear whether peripherally inserted central catheters (PICCs) are superior to central venous catheters (CVCs); therefore, we compared post-implantation complications between CVC and PICC groups.

RESEARCH DESIGN AND METHODS

Patients who received CVCs or PICCs between April 2010 and March 2018 were identified from the Diagnosis Procedure Combination database, a national inpatient database in Japan. The outcomes of interest included catheter infection, pulmonary embolism, deep vein thrombosis, and phlebitis. Propensity score overlap weighting was used to balance patient backgrounds. Outcomes were compared using logistic regression analyses.

RESULTS

We identified 164,185 eligible patients, including 161,605 (98.4%) and 2,580 (1.6%) in the CVC and PICC groups, respectively. The PICC group was more likely to have overall complications (odds ratio [OR], 1.70; 95% confidence interval [CI], 1.32-2.19), pulmonary embolism (OR, 2.32; 95% CI, 1.38-3.89), deep vein thrombosis (OR, 1.86; 95% CI, 1.16-2.99), and phlebitis (OR, 1.72; 95% CI, 1.27-2.32) than the CVC group. There was no significant intergroup difference in catheter infection (OR, 1.09; 95% CI, 0.39-3.04).

CONCLUSIONS

Patients with PICCs had a significantly greater incidence of complications than did those with CVCs. Further research is necessary to explore the factors contributing to these complications.

Study on PTFE superhydrophobic coating modified by IC@dMSNs and its enhanced antibacterial effect

INTRODUCTION

Vascular catheter-related infections and thrombosis are common and may lead to serious complications after catheterization. Reducing the incidence of such infections has become a significant challenge.

OBJECTIVES

This study aims to develop a super hydrophobic nanocomposite drug-loaded vascular catheter that can effectively resist bacterial infections and blood coagulation.

METHODS

In this study, a SiO2 nanocoated PTFE (Polytetrafluoroethylene) catheter (PTFE-SiO2) was prepared and further optimized to prepare a SiO2 nanocoated PTFE catheter loaded with imipenem/cilastatin sodium (PTFE-IC@dMSNs). The catheters were characterized for performance, cell compatibility, anticoagulant performance, in vitro and in vivo antibacterial effect and biological safety.

RESULTS

PTFE-IC@dMSNs catheter has efficient drug loading performance and drug release rate and has good cell compatibility and anticoagulant effect in vitro. Compared with the PTFE-SiO2 catheter, the inhibition ring of the PTFE-IC@dMSNs catheter against Escherichia coli increased from 3.98 mm2 to 4.56 mm2, and the antibacterial rate increased from about 50.8 % to 56.9 %, with a significant difference (p < 0.05). The antibacterial zone against Staphylococcus aureus increased from 8.63 mm2 to 11.74 mm2, and the antibacterial rate increased from approximately 83.5 % to 89.3 %, showing a significant difference (p < 0.05). PTFE-IC@dMSNs catheter also has good biocompatibility in vivo. Furthermore, the PTFE-IC@dMSNs catheter can reduce the adhesion of blood cells and have excellent anticoagulant properties, and even maintain these properties even with the addition of imipenem/cilastatin sodium.

CONCLUSION

Compared with PTFE, PTFE-SiO2 and PTFE-IC@dMSNs catheters have good characterization performance, cell compatibility, and anticoagulant properties. PTFE SiO2 and PTFE-IC@dMSNs catheters have good antibacterial performance and tissue safety against E. coli and S. aureus. Relatively, PTFE-SiO2 and PTFE-IC@dMSNs catheter has better antibacterial properties and histocompatibility and has potential application prospects in anti-bacterial catheter development and anticoagulation.

Impact of a midline catheter prioritization initiative on device utilization and central line-associated bloodstream infections at an urban safety-net community hospital

Overuse of peripherally inserted central catheters (PICCs) can lead to idle central line (CL) days and increased risk for CL-associated bloodstream infections (CLABSIs). We established a midline prioritization initiative at a safety-net community hospital. This initiative led to possible CLABSI avoidance and a decline in PICC use.

Ultrasonographic Findings of Catheter-Related Bloodstream Infection in Pediatric Patients

BACKGROUND

Catheter removal is essential for treating catheter-related bloodstream infection (CRBSI); however, clinicians are sometimes hesitant to remove catheters in pediatric patients due to the difficulty of securing vascular access. Confirming the diagnosis of CRBSI is important to justify catheter removal. The purpose of this study was to describe the sonographic findings of CRBSI.

MATERIALS AND METHODS

We included patients with a central venous catheter (CVC) or peripherally inserted central catheter (PICC) who had a positive blood culture and underwent ultrasound. The patients were classified as with or without CRBSI. Sonographic findings, such as the presence/absence of thrombus, venous wall thickening, hyperechogenicity, and fluid collection around the vein were compared using Fisher's exact test.

RESULTS

Of the 58 patients, 38 (66%) were diagnosed with CRBSI. The presence of thrombus (19/38 vs 3/20, P = .011); and hyperechogenicity around the vein (14/38 vs 2/20, P = .035) differed significantly, but There was no significant difference in the presence of venous wall thickening (10/38 vs 1/20, P = .077), and fluid collection around the vein (5/38 vs 0/20, P = .153), did not differ significantly in patients with and without CRBSI, respectively. One-third of patients with CRBSI, including 11 (42.3%) patients with CVC, and 2 (16.7%) patients with PICC, did not have abnormal sonographic findings.

CONCLUSION

Ultrasound findings are useful for diagnosing CRBSI. However, the sensitivity of sonographic findings is low and abnormal sonographic findings are sometimes absent in children with CRBSI; therefore, physicians should not rule out CRBSI based on normal sonographic findings, especially in patients a CVC and a positive blood culture.

Peripherally inserted central catheter securement with cyanoacrylate glue and bloodstream infection: A retrospective cohort study

BACKGROUND

Treatment via a peripherally inserted central venous catheter is important for anticancer treatment, perioperative management, and nutrition management. In this study, we aimed to investigate the usefulness of cyanoacrylate glue (CG) in managing peripherally inserted central venous catheters in adults.

METHODS

This retrospective cohort study enrolled 411 adults requiring a central venous catheter for treatment in the Chiba University Esophageal-Gastro-Intestinal Surgery department between January 2021 and October 2022. The preventive effect of CG in reducing adverse events, including infection, tip migration, and thrombus formation, was evaluated by reviewing electronic medical records, chest radiographs, and contrast-enhanced computed tomography scans.

RESULTS

CG and other dressings were used in 158 (CG group) and 253 (control group) patients, respectively. The incidence of catheter infection based on the clinical course was lower in the CG group (3.2%) than in the control group (9.1%; P = 0.03). However, cases of infection confirmed by blood or catheter cultures did not differ between the CG (1.3%) and control (1.9%) groups (P = 1.0). Chest radiographs revealed that catheter tip migration (mean ± SD) was lesser in the CG group (8.2 ± 6.7 mm) than in the control group (15.0 ± 15.8 mm; P < 0.01). There were two cases of venous thrombus formation in the control group.

CONCLUSION

In a population dominated by esophago-gastroenterological malignancy, peripherally inserted central catheter securement via CG was associated with decreased catheter removal because of suspected catheter infection. Further research on larger cohorts is needed to determine if other adverse events decrease following peripherally inserted central catheter securement via CG.

Serious Adverse Events and Laboratory Monitoring Regimens for Outpatient Parenteral Antimicrobial Therapy With Cefazolin and Ceftriaxone

The optimal laboratory monitoring frequency for outpatient parenteral antimicrobial therapy-related adverse events (OPAT-AEs) during cefazolin and ceftriaxone therapy is not well defined. We identified 2.7 OPAT-AEs per 1000 sets of weekly laboratory tests in this population, suggesting that less intensive laboratory monitoring may be safe and reasonable.

Making a difference? A retrospective review of peripherally inserted central catheters: A single-center experience in Colombia

Introduction

Peripherally inserted central catheters (PICCs) are an effective tool as a medical device in patients who require them. However, it is a procedure that has been associated with multiple complications and possible negative outcomes for the health of the patients. This paper seeks to describe the main complications derived from the insertion and maintenance of peripherally inserted central venous catheters (PICCs), based on the experience of a vascular accesses group in a cardiovascular center in Colombia.

Methods

A retrospective cross-sectional analytical study of the adult population undergoing PICC insertion at the Fundación Cardioinfantil-Instituto de Cardiología, during the period between 2019 and 2020 by the vascular access program, was performed.

Results

The frequency of any registered complication was 15.9% for 2019 and 11.2% for 2020. Bleeding at the procedure site occurred in 15.3% during 2019 and 7.0% in 2020, making it the most frequent complication during the procedure. All the variables of complications associated with infection (bacteremia, phlebitis, and catheter-related infection) showed a decrease in 2020 compared to the previous year. The central line-associated bloodstream infection registered for the year 2019 was 1.94 bacteremia's/1000 catheters-day compared to 0.29 bacteremia's/1000 catheters-day.

Conclusions

There has been a 4.7% reduction in the frequency of any registered complication after the implementation of the vascular access groups. Global and specific complications decreased significantly from 2019 to 2020. Notably, bacteremia, a common post-procedure complication, showed a substantial decrease in frequency compared to national and worldwide literature. It is also been described that complications associated with infection showed a decrease in 2020 compared to 2019. Whether or not all these findings are directly or somewhat related to the results stemming from the vascular access groups still needs further investigation.