Integrated short peripheral intravenous cannulas and risk of catheter failure: A systematic review and meta-analysis

Antonio Gidaro; Massimiliano Quici; Davide Giustivi; Fulvio Pinelli; Federica Samartin; Francesco Casella; Chiara Cogliati; Giulia Rizzi; Emanuele Salvi; Arianna Bartoli; Antonella Foschi; Roberto Castelli; Maria Calloni; Marco Gemma

doi:10.1177/11297298231218468

Integrated short peripheral intravenous cannulas and risk of catheter failure: A systematic review and meta-analysis

J Vasc Access. 2024 Jan 2:11297298231218468. doi: 10.1177/11297298231218468. Online ahead of print.

Affiliations

¹ Department of Biomedical and Clinical Sciences "Luigi Sacco," University of Milan, Luigi Sacco Hospital, Milan, Italy.
² Emergency Department ASST Lodi, Lodi, Italy.
³ Department of Infectious Diseases, Luigi Sacco Hospital, Milan, Italy.
⁴ Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy.
⁵ UOC Intensive Care Unit-Neuroanesthesia and Reanimation IRCCS Carlo Besta Neurological Institute Foundation, Milan, Italy.

PMID: 38166435
DOI: 10.1177/11297298231218468

Abstract

Background: Short peripheral catheters (SPCs) are used to provide intravenous therapies in hospitalized patients. Recently, the category of SPC has become more complex, with the introduction in clinical practice of "integrated" SPCs (ISPCs), renewed regarding the material (polyurethane rather than polytetrafluoroethylene) and design (large wing; pre-assembled extension; preassembled needle-free connector (NFC)).

Methods: This systematic review and meta-analysis aimed to analyze randomized controlled trials (RCTs) and quasi-randomized studies in hospitalized patients, analyzing the risk of overall catheter failure as well as the risk of each type of complication (occlusion, infiltration, thrombophlebitis, and dislodgement) for ISPCs compared to non-integrated SPCs. These systematic review and meta-analysis were registered on PROSPERO (CRD42022322970).

Data sources: We searched PUBMED^®, EMBASE^®, and the Cochrane Controlled Clinical Trials register from April to November 2022.

Results: included studies: The research identified 1260 articles. After the abstract review, 13 studies were included for full manuscript review and, after that, six papers (4727 patients) were included in the meta-analysis.

Description of the effect: We found a significantly reduced risk of catheter failure (pooling all complications) for ISPCs compared to SPCs (p = 0.002 RR 0.65; 95% CI 0.63-0.9). A significant reduction in the risks of occlusion (p = 0.007 RR 0.72; 95% CI 0.56-0.92) was observed. As regards the risk of infiltration, thrombophlebitis, and dislodgement, the analysis showed a trend in favor of ISPCs, though not statistically significant (respectively p = 0.2 RR 0.84; 95% CI 0.64-1.1; p = 0.25 RR 0.91; 95% CI 0.78-1.07; p = 0.06 RR 0.72; 95% CI 0.52-1.01).

Conclusions: ISPCs significantly reduce the risks of catheter failure (overall complications) and occlusion. More RCTs are needed to understand if the preassembled ISPC is better than the composted closed system (non-integrated SPC + extension line + NFC).

Keywords: Short peripheral intravenous catheters (SPCs); dislodgment; infiltration; integrated short peripheral intravenous catheters (ISPCs); occlusion; phlebitis.