Background: Patients with cancer require reliable venous access for therapy. Although peripherally inserted central catheters (PICCs) and implanted ports are often used to meet infusion needs, risk of complications between these devices is unknown. We did a systematic review and meta-analysis to compare the risk of deep vein thrombosis (DVT), exit-site complications and central line-associated bloodstream infection (CLABSI) associated with PICCs versus ports in patients with cancer.
Methods: We searched Medline, Embase, Scopus and Web of Science core collection. Hand searches of bibliographies, internet searches, and device manufacturer sites were also performed. We contacted study authors to obtain unpublished data. All studies were of pediatric or adult patients that received a port or a PICC in the setting of active cancer. Studies were assessed via the Cochrane Risk of Bias Tool and the Newcastle-Ottawa risk of bias scale. Summary odds ratios (ORs) for the outcomes of DVT, exit-site complications and CLABSI were calculated using random effects meta-analysis.
Results: Of the 2,689 studies identified, 13 articles that compared PICCs to ports including 7,521 patients met eligibility criteria. Meta-analysis of 10 studies comparing the risk of DVT related to ports with that of PICCs showed that ports were associated with a lower risk of thrombosis (OR 0.22, 0.14-0.36, p<0.001). With a baseline DVT rate of 2.56%, the number needed to treat to prevent one DVT was 50 (95% CI 46, 62). Meta-analysis of seven studies of 1,415 patients showed no difference in the odds of exit-site complications in those that received ports vs. PICCs (OR 0.80, 0.46-1.40, p=0.435). Meta-analysis of five studies of 6,599 patients showed that ports were associated with a decrease in the odds of CLABSI compared to PICCs (OR 0.32, 0.17-0.59, p<0.001).
Conclusions: In patients with cancer, ports are associated with a lower risk of DVT and CLABSI than PICCs. These findings suggest that preferential use of ports in patients with cancer may help improve patient safety.
