Comparative meta-analysis of complications in implantable port catheters versus peripherally inserted central catheters in chemotherapy-treated cancer patients

Abstract

Mohamed S. Imam*, Jawaher A. Ajeebi, Manal khaled Saeed Alharthi, Bayan Sami Altalhi, Raghad Sultan Alosaimi, Ghada Attaih Alzahrani, Layan Wadea Saad Alosaimi, Hawra Redha Abuayfah, Faisal Abdulaziz Abdullah Alshareef, Wajin Rubayyi Q. Alruwely, Waad Mohammed Abdullah Alamri, Nasser Mutiq Almuthaybiri, Khalid Sinhat Alotaibi, Hussain Ali Abdullah Alhammad and Abdulaziz Jameel Saud Alotaibi

Background and objectives: A meta-analysis compared complications associated with Peripherally Inserted Central Catheters (PICCs) and Implanted Port Catheters (IPCs) in cancer patients undergoing chemotherapy.

Methods: A comprehensive literature search up to December 2024, involving 12,587 participants, was analyzed using pooled Odds Ratios (ORs) and Mean Differences (MDs) with 95% Confidence Intervals (CIs). Dichotomous and continuous outcome measures were evaluated via random-effects or fixed-effects models.

Results: Results revealed that PICC use was linked to significantly elevated risks of occlusion (OR 4.39; 95% CI 2.95-6.52, p<0.001), catheter-related infections (OR 2.42; 95% CI 1.34-4.36, p=0.003), malposition (OR 7.39; 95% CI 3.52-15.50, p<0.001), thrombosis (OR 2.88; 95% CI 2.05-4.05, p<0.001), phlebitis (OR 6.41; 95% CI 2.90-14.14, p<0.001), and accidental removal (OR 3.38; 95% CI 1.97-5.81, p<0.001), alongside a notably shorter indwelling duration (MD -233.16 days; 95% CI -449.52 to -16.80, p=0.03) compared to IPC. However, no significant differences were found in puncture-site local infection rates (OR 1.79; 95% CI 0.88-3.64, p=0.11) or cost (MD -394.02; 95% CI -882.19 to 94.14, p=0.11) between the two devices.

Conclusion: Patients with PICCs experienced significantly more complications than those with IPCs, especially cancer patients undergoing chemotherapy. These complications included occlusions, catheter-related infections, malposition, catheter-related thrombosis, phlebitis, accidental removal, and shorter catheter lifespan. While IPC users experienced fewer of these issues, local insertion site infection duration and costs were comparable between the two groups.

However, the limited sample sizes in seven of the 31 studies included, and the small number of studies contributing to some comparisons, warrants cautious interpretation of these results.