SYSTEMATIC REVIEW article
Front. Nutr.
Sec. Clinical Nutrition
Comparison of catheter-related bloodstream infection between peripherally inserted central catheters and tunneled central venous catheters in home parenteral nutrition: a meta-analysis
Provisionally accepted
- Zhejiang Kangjing Hospital, Hangzhou, China
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Abstract Background: Catheter-related bloodstream infection (CRBSI) remains one of the most severe complications in patients receiving home parenteral nutrition. Tunneled central venous catheters (CVCs) and peripherally inserted central catheters (PICCs) are the most used home parenteral nutrition. However, their relative risk of CRBSI remains controversial. This meta-analysis aimed to compare the incidence of CRBSI between PICCs and tunneled CVCs in patients receiving home parenteral nutrition. Methods: A systematic search of PubMed, Embase, and the Cochrane Library was conducted from database inception to June 3, 2025, to identify studies comparing CRBSI incidence between PICCs and tunneled CVCs in patients receiving home parenteral nutrition. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated to assess the relative risk of CRBSI associated with PICCs versus tunneled CVCs based on fixed-effect model or random-effect model. The certainty of evidence was assessed using the GRADE approach. Results: A total of 10 articles (involving 1139 PICCs and tunneled CVCs) were included in the meta-analysis. The mean prevalence of CRBSI rate was 0.77 per 1000 PICC-days and 1.01 per 1,000 tunneled CVC-days. The pooled analysis demonstrated that PICCs were associated with a significantly lower risk of CRBSI compared with tunneled CVCs (RR:0.40, 95%CI:0.33-0.49). Subgroup analysis based on study design, population, and CRBSI definition. Subgroup analyses stratified by study design, patient population, and CRBSI definition yielded consistent results, confirming the robustness of the main findings. According to GRADE, the quality of evidence was very low for CRBSI rate. Conclusion: PICCs were associated with a lower risk of CRBSI than tunneled CVCs in patients receiving home parenteral nutrition. However, the certainty of evidence was very low, these findings should be interpreted with caution, and further high-quality studies are needed
Keywords: Central Venous Catheters, CRBSI, homeparenteral nutrition, Meta-analysis, peripherally inserted central catheters
Received: 09 Nov 2025; Accepted: 27 Jan 2026.
Copyright: © 2026 Zheng, Wang, Qi, Zhang and Lin. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Peiyan Lin
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