Central line associated blood stream infectionsin peripherally-inserted versus centrally-inserted, non-implanted, central venous catheters

Abstract

Overview of the topic: Central Line Associated Blood-Stream Infections (CLABSI) are a health-care associated complication which increase morbidity and mortality, lengthen hospital stay and financially burden health-care systems around the globe (Aloush & Alsaraireh, 2018). Two types of central catheters were compared to evaluate whether a significant discrepancy exists, in terms of CLABSI, between these devices. Clinical enquiry: Are PICC lines associated with a lower risk of Catheter Related Blood Stream Infections (CRBSI) when compared to non-implanted Central Venous Catheters (CVC)? PICO elements: The studied population (P) were patients that required central venous access devices (CVAD) such as, peripherally inserted central catheters (PICCs) (I), and centrally inserted, non-implanted, central venous catheters (CVCs) (C). The outcomes measured (O) during the research process were complications associated with the compared devices such as, CLABSI or CRBSI. Method: The strategy included a combination of key terms (Table 2.1) with the use of Boolean and truncation operators. Hy-Di advanced search tool was utilized, where all available data bases, mainly EBSCO and PubMed, were scanned. The application of inclusion and exclusion criteria allowed to filter search results and retrieve ten relevant articles. The Critical Appraisal Skills Programme (CASP) tool was used for quality assessment. Results: Two systematic reviews and eight cohort studies were chosen for the review. One article, a systematic review, was found irrelevant because of insufficient sample size and intrinsic discrepancy. Only one of the appraised literature favored CVCs over PICCs in terms of CLABSI. This observational study compared a specific type of CVC, the Hickman’s® catheter. Five studies favored PICCs and three claimed no significant difference in CLABSI rate. Conclusion: PICC lines were found to have a lower CLABSI rate, when compared to standard CVCs. Recommendations: Further contemporary research, focused on CLABSI rates in standard CVCs versus PICC lines, and of a higher ranking in the hierarchy of evidence, is desired. The human factor, the adherence to standard infection precautions, ought to be analyzed and systematically appraised in future scientific literature.