Peripherally inserted versus centrally inserted central venous catheters: A systematic review and meta-analysis of efficacy and complications

Objective To assess the efficacy and safety of peripherally inserted central catheters (PICCs) compared with central venous catheters (CVCs) regarding success rates and adverse events in hospitalized patients. Methods A systematic review and meta-analysis was conducted following the PRISMA guidelines, using the Medline/PubMed, Embase, and LILACS databases. The study was prospectively designed, and the protocol was published in advance. Two reviewers independently performed study selection, data extraction, and risk of bias assessment using the Cochrane Risk of Bias 2 tool. Random effects meta-analyses with restricted maximum likelihood were performed for the following outcomes: success rate, deep vein thrombosis, catheter failure, insertion-related trauma, infection, and reintervention. Results A total of 11,342 records were identified, and 9 randomized controlled trials met the eligibility criteria. Most studies (75%) presented a high risk of bias. No significant differences were found between PICCs and CVCs regarding success rate (risk ratio [RR], 1.00; 95% confidence interval [CI], 0.99-1.01), thrombosis (RR, 1.06; 95% CI, 0.32-3.56), catheter failure (RR, 0.57; 95% CI, 0.13-2.42), or reintervention (RR, 1.44; 95% CI, 0.51-4.08). PICCs were associated with a significantly lower risk of infection (RR, 0.26; 95% CI, 0.15-0.45). Conclusions PICCs demonstrate comparable efficacy to CVCs across key procedural and mechanical outcomes, with the distinct advantage of reducing infection risk. This evidence supports the preferential use of PICCs for infection prevention in critically ill and oncologic patients.