# Comparison of catheter-related bloodstream infection between peripherally inserted central catheters and tunneled central venous catheters in patients receiving home parenteral nutrition: a meta-analysis

## TL;DR

This study compares infection risks between two types of catheters used for home nutrition and finds one type has a lower infection risk, though the evidence is weak.

## Contribution

A meta-analysis comparing CRBSI rates between PICCs and tunneled CVCs in home parenteral nutrition patients.

## Key findings

- PICCs had a lower CRBSI rate (0.77 per 1,000 days) compared to tunneled CVCs (1.01 per 1,000 days).
- The pooled analysis showed PICCs significantly reduced CRBSI risk (RR: 0.40, 95% CI: 0.33–0.49).
- Subgroup analyses confirmed consistent results, but evidence quality was very low.

## Abstract

Catheter-related bloodstream infection (CRBSI) remains one of the most severe complications in patients receiving home parenteral nutrition. Tunneled central venous catheters (CVCs) and peripherally inserted central catheters (PICCs) are the most commonly used devices for home parenteral nutrition. However, the relative risks of CRBSI from these devices remain controversial. This meta-analysis aimed to compare the incidence of CRBSI between PICCs and tunneled CVCs in patients receiving home parenteral nutrition.

A systematic search of PubMed, Embase, and the Cochrane Library databases was conducted from database inception to 3 June 2025 to identify studies comparing the incidence of CRBSI between PICCs and tunneled CVCs in patients receiving home parenteral nutrition. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated to assess the relative risk of CRBSI associated with PICCs versus tunneled CVCs using either the fixed-effects model or the random-effects model. The certainty of evidence was assessed using the GRADE approach.

A total of 10 articles, involving 1,139 patients with PICCs or tunneled CVCs, were included in the meta-analysis. The mean CRBSI rate was 0.77 per 1,000 PICC-days and 1.01 per 1,000 tunneled CVC-days. The pooled analysis demonstrated that PICCs were associated with a significantly lower risk of CRBSI compared with tunneled CVCs (RR:0.40, 95%CI:0.33–0.49). Subgroup analyses stratified by study design, patient population, and CRBSI definition yielded consistent results, confirming the robustness of the primary findings. According to the GRADE approach, the quality of evidence was very low for the CRBSI rate.

PICCs were associated with a lower risk of CRBSI than tunneled CVCs in patients receiving home parenteral nutrition. However, the certainty of evidence was very low; therefore, these findings should be interpreted with caution, and further high-quality studies are needed.