Risk Of Catheter-Related Bloodstream Infection Associated With Midline Catheters Compared With Peripherally Inserted Central Catheters: A Meta-Analysis

Background: Both midline catheters (MCs) and peripherally inserted central catheters (PICCs) can cause catheter-related bloodstream infection (CRBSI), but the prevalence associated with each is not clear.Objective: To compare the risk of CRBSI between MCs and PICCs with a meta-analysis.Methods: The Web of Science Core Collection, PubMed, Scopus, Embase, The Cochrane Library and ProQuest were searched. All studies comparing the risk of CRBSI between MCs and PICCs were included. Selected studies were assessed for methodological quality using the Downs and Black checklist. Two authors independently assessed the literature and extracted the data. A fixed effects model was used to generate estimates of CRBSI risk in patients with MCs versus PICCs. Publication bias was evaluated, and meta-analyses were conducted with RevMan 5.3.Results: A total of 167 studies were identified. Ten studies were collected, involving 33,322 patients. The prevalence of CRBSI with MCs and PICCs was 0.58% (40/6,900) and 0.48% (127/26,422), respectively. Meta-analysis showed that the prevalence of CRBSI was not significantly different between MCs and PICCs (RR = 0.77, 95% CI: 0.50-1.17, p = .22). While the result showed that the prevalence of CRBSI with MCs was lower than that with PICCs (RR = 0.55, 95% CI: 0.33-0.92, p = .02) after poor-quality studies were removed. The sensitivity analysis shows that the results from this meta-analysis are fair in overall studies and non-poor-quality studies. All studies have no significant publication bias.Conclusions: This study provides the first systematic assessment of the risk of CRBSI between MCs and PICCs and provides evidence for the selection of appropriate vascular access devices for intravenous infusion therapy in nursing. The prevalence of CRBSI was not significantly different between them.