Tunneled Peripherally Inserted Central Catheters and Bloodstream Infection: A Systematic Review and Meta-Analysis

Purpose: We aimed to determine whether central line-associated bloodstream infection (CLABSI) rates differ between tunneled and conventionally inserted PICCs (tPICCs and cPICCs). Materials and Methods: This systematic review and meta-analysis was prospectively registered in PROSPERO (CRD42024616470) and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Embase, and the Cochrane Library were comprehensively searched from inception to November 27, 2024, to identify randomized controlled trials that compared CLABSI rates between tPICCs and cPICCs. Risk ratios along with the 95% confidence intervals (CI) were calculated for outcomes using a random-effects meta-analysis model following the Hartung-Knapp-Sidik-Jonkman method. Statistical heterogeneity was assessed using the I² statistic. Methodological quality and risk of bias were assessed using the Cochrane risk of bias tool. Results: A meta-analysis of four relevant studies, comprising 2,659 participants (pooled mean age ± standard deviation, 59.3 ± 15.5 years; 1,481 women) and 177,879 catheter days, revealed overall CLABSI rates of 0.31 per 1,000 catheter-days in the tPICC group and 0.68 per 1,000 catheter-days in the cPICC group. The risk ratio (0.48; 95% CI, 0.28–0.81; p = 0.02) indicated a 52% reduction in the tPICC group compared with the cPICC group, with low heterogeneity (I² = 0%). Conclusion: Subcutaneous tunneling for PICC placement is associated with a significant reduction in CLABSI rate among hospitalized adult patients.