Wong Clement Chun-Him, Choi Horace Cheuk-Wai, Lee Victor Ho-Fun
LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
Cancers (Basel). 2023 Sep 25;15(19):4712. doi: 10.3390/cancers15194712.
(1) Background: Central venous access devices (CVADs) have been commonly employed during various courses of anticancer treatment. Currently, there are a few types of clinically available CVADs, which are associated with short-term and long-term complications. However, little is known about the complication rates when CVADs are used only in palliative care settings. We therefore performed a systematic review and meta-analysis of all the published literature to evaluate the complication rates of CVADs in this clinical setting. (2) Methods: A systematic review and meta-analysis were conducted to identify publications from PubMed/MEDLINE, Embase (Ovid), Scopus, Cochrane Library, CINAHL, Google Scholar, and trial registries. Publications reporting the complication rates of PICCs, central lines, and PORTs in palliative settings for terminally ill cancer patients were included, while those on the use of systemic anticancer therapy and peripheral venous catheters were excluded. The outcome measures included overall complication rate, rate of catheter-related bloodstream infection (CRBSI), and rate of thromboembolism (TE). This systematic review was registered with PROSPERO (CRD42023404489). (3) Results: Five publications with 327 patients were analyzed, including four studies on PICCs and one study on central lines. No studies on PORTs were eligible for analysis. The overall complication rate for PICCs (pooled estimate 7.02%, 95% CI 0.27-19.10) was higher than that for central lines (1.44%, 95% CI 0.30-4.14, = 0.002). The risk of CRBSI with PICCs (2.03%, 95% CI 0.00-9.62) was also higher than that with central lines (0.96%, 95% CI 0.12-3.41, = 0.046). PICCs also had a trend of a higher risk of TE (2.10%, 95% CI 0.00-12.22) compared to central lines (0.48%, 95% CI 0.01-2.64, = 0.061). (4) Conclusions: PICCs for palliative cancer care were found to have greater complications than central lines. This might aid in the formulation of future recommendation guidelines on the choice of CVAD in this setting.
（1）背景：中心静脉通路装置（CVADs）在各种抗癌治疗过程中已被广泛应用。目前，临床上有几种类型的CVADs，它们与短期和长期并发症相关。然而，对于仅在姑息治疗环境中使用CVADs时的并发症发生率知之甚少。因此，我们对所有已发表的文献进行了系统评价和荟萃分析，以评估在这种临床环境中CVADs的并发症发生率。（2）方法：进行系统评价和荟萃分析，以确定来自PubMed/MEDLINE、Embase（Ovid）、Scopus、Cochrane图书馆、CINAHL、谷歌学术和试验注册库的出版物。纳入报告终末期癌症患者姑息治疗环境中经外周静脉穿刺中心静脉置管（PICCs）、中心静脉导管和植入式静脉输液港（PORTs）并发症发生率的出版物，排除使用全身抗癌治疗和外周静脉导管的相关文献。结局指标包括总体并发症发生率、导管相关血流感染（CRBSI）发生率和血栓栓塞（TE）发生率。该系统评价已在国际前瞻性系统评价注册库（PROSPERO）注册（注册号：CRD42023404489）。（3）结果：分析了5篇包含327例患者的出版物，其中包括4项关于PICCs的研究和1项关于中心静脉导管的研究。没有关于PORTs的研究符合分析条件。PICCs的总体并发症发生率（合并估计值7.02%，95%可信区间0.27 - 19.10）高于中心静脉导管（1.44%，95%可信区间0.30 - 4.14，P = 0.002）。PICCs发生CRBSI的风险（2.03%，95%可信区间0.00 - 9.62）也高于中心静脉导管（0.96%，95%可信区间0.12 - 3.41，P = 0.046）。与中心静脉导管相比，PICCs发生TE的风险也有升高趋势（2.10%，95%可信区间0.00 - 12.22），而中心静脉导管为（0.48%，95%可信区间0.01 - 2.64，P = 0.061）。（4）结论：发现用于姑息性癌症护理的PICCs比中心静脉导管有更多并发症。这可能有助于制定在这种情况下选择CVADs的未来推荐指南。
