Peripherally inserted central catheters (PICCs) have a 29% complication rate. This systematic review evaluated 25 interventions to prevent PICC-associated infectious and noninfectious complications in participants of all ages.MethodsWe searched electronic databases (MEDLINE, Embase, Cochrane Library, World Health Organization Global Index Medicus, CINAHL) and reference lists for randomized (RCTs) and nonrandomized controlled trials published between 1 January 1980-8 May 2024. We dually selected studies, assessed risk of bias, extracted data, and rated certainty of evidence (COE). We included single interventions of interest and combinations of at least 2 (bundle/multimodal). If 3 or more RCTs existed, we conducted Bayesian random-effects meta-analyses.ResultsSeventy-four studies met our eligibility criteria (60 evaluated single interventions, 14 bundle/multimodal), addressing 13 of 25 research questions. The majority were conducted in high-income countries; 36 focused on neonates. Evidence was very uncertain for 11 of the 13 research questions. Stronger COE showed that ultrasound-guided catheter insertion reduced phlebitis/thrombophlebitis in adults compared with non–ultrasound-guided (5 RCTs; risk ratio [RR], 0.19; 95% credible interval, .08–.50); silicone catheters increased phlebitis/thrombophlebitis compared with nonsilicone (1 RCT; RR, 2.00; 95% confidence interval [CI], 1.26–3.17). Bundle interventions decreased local infections (1 RCT; RR, 0.47; 95% CI, .31–.72) and phlebitis/thrombophlebitis in adults (1 RCT; RR, 0.35; 95% CI, .22–.56) compared with routine care.ConclusionsUltrasound-guided catheter insertion and nonsilicone catheters effectively prevented PICC complications. The evidence for other comparisons was too uncertain to draw conclusions, highlighting the urgent need for additional studies on prevention and control interventions.

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In this article recently published in Clinical Infectious Diseases, Andreea Dobrescu and colleagues assessed 25 interventions to prevent complications associated with peripherally inserted central catheters. The review highlights the effectiveness of ultrasound-guided catheter insertion and nonsilicone catheters in reducing complications.