Background: Peripherally inserted central catheters (PICCs) are increasingly used in the care of hospitalized patients. While major complications such as venous thromboembolism and central line-associated bloodstream infection related to PICCs have been well reported, comparatively less attention has been given to minor complications such as occlusion associated with PICCs. This knowledge gap is important because PICC occlusion is associated with substantial consequences to patients, including delays in drug delivery, need for tPA, and, if irreversible, device exchange or removal. Therefore, we conducted a systematic review and meta-analysis to examine the risk of occlusion in patients who received PICCs vs. other non-PICC devices including peripheral and central venous catheters (CVCs).
Methods: We followed PRISMA guidelines and searched for eligible, full-length, peer-reviewed studies in the following databases: Medline via Ovid (1950-present), Embase (1946-present), Cochrane CENTRAL (1948-present), CINAHL (1960-present), and Web of Science via Scopus. Two authors independently reviewed and abstracted studies if they: (a) included adults that received PICCs; (b) compared PICCs to non-PICC devices (e.g., peripheral IVs, tunneled catheters or ports); and (c) reported on outcomes of interest including occlusion. Risk of bias was assessed using the Newcastle Ottawa Scale and the Cochrane Risk of Bias Assessment Tool independently and in duplicate by two authors. Odds ratios for risk of occlusion with PICCs vs. non-PICC devices were generated using Der-Simonian Laird random effects meta-analysis. Between-study heterogeneity was assessed by I2 and Cochrane’s Q statistic.
Results: A total of 8 studies met inclusion criteria. Included studies originated from various regions including the United States, United Kingdom, Japan, and China. With respect to study design, 3 studies were prospective cohort studies, 3 retrospective cohort studies and 2 randomized trials. The sample size of included studies varied from 40 patients to 328 patients. PICCs and non-PICC devices were most often inserted in cancer patients for chemotherapy (6 studies). The incidence of PICC occlusion across studies ranged from 2% to 20%. PICCs were compared to various devices: Three studies compared ports to PICCs, 2 compared peripheral devices (midline and peripheral IVs) to PICCs, 2 compared tunneled CVCs to PICCs and 1 compared non-tunneled central venous catheters to PICCs. Pooled results revealed that PICCs were associated with nearly 7-fold greater risk of occlusion compared to non-PICC CVCs (OR=6.77, 95% CI=1.62-28.77, I2=66.9%, p=0.006). Rates of PICC occlusion were greatest in studies that compared ports to PICCs. Results remained robust to analyses based upon region and study quality. Heterogeneity in pooled analyses was resolved by comparator.
Conclusion: Compared to non-PICC devices, PICCs are associated with higher rates of occlusion. Appropriate care and maintenance of PICCs, including close attention to flushing are needed to ensure the safety of these devices.