Comparation The Adverse Events Rate And Costs Between TIVAP And PICC In Cancer Patients:a Meta Analysis

Totally Implantable Venous Access Port(TIVAP)and Peripherally Inserted Central Catheters(PICC)are the two most widely used central venous pathways in tumor patients undergoing chemotherapy or total parenteral nutrition.TIVAP has a longer service life than PICC,which has a lower initial cost than TIVA.However,there is no good guideline for clinicians to use them safely in patients at the lowest cost.Therefore,to compare the complications and costs of TIVAP and PICC in tumor patients,as well as their respective advantages and disadvantages,including line occlusion,infection,catheter-related thrombosis,exudation,phlebitis,dislocation and accidental extraction rate,etc,which can provide clinicians with a basis for better decisions for patients.By being familiar with their usage,related complications,and the diagnosis and management of complications,doctors can better ensure the safety of patients and reduce their additional financial burden.Methods:In strict accordance with the requirements of cochrane’s operational guidelines for systematic review and Meta-analysis,we searched the National Library of Medicine(NLM),Joanna Briggs Institute,JBI),Cochrane Library,Web of Science,CINAHL Database,China Biomedical Disc(CBM),China National Knowledge Infrastructure,CNKI),Google Scholars and other databases,and comprehensively searched out the English literature of retrospective studies on the application of TIVAP and PICC in cancer patients.The case-control study quality assessment scale(New Castle-Otta WA QUALITY Assessment Scale,NOS Scale)was adopted to evaluate the cases of each case-control study from three dimensions:case selection,comparability and exposure,with a full score of 9.The life of catheter,catheter-related complications such as catheter occlusion,catheter-related infection,catheter malposition,catheter-related thrombosis,allergy caused by catheter retention,pain caused by catheter retention and the total cost of catheter use in each case were extracted,and the cost was also divided into 6 months’cost and 12 months’cost and other related data.Two examiners work together to complete screening,test selection,quality evaluation,data extraction,etc.When they meet with differences,they will reach a consistent result through joint discussion,so as to determine the final score and include it in the article.The data obtained were analyzed by Meta with STATA10 software,and the odds ratio(Odds Ratio,OR)and 95%confidence interval(Confidence Interval,CI)were used to evaluate binary variables,in which OR=1 means that the incidence of the two groups is equal,and the incidence of the two groups is not statistically significant,and the invalid vertical line of the forest map of OR value is at Abscissa=1.Standard mean difference(Standardized Mean Difference,SMD)is used to calculate continuous variables such as catheter life and catheter-related total cost,which is the difference of the mean of the test group minus the mean of the control group.SMD=0 represents that the mean of the two groups is not statistically significant,so the invalid vertical line of the forest map of SMD is at Abscissa=0.The I~2 test is used to test the heterogeneity of the differences among the test groups.When I~2<25%,it is considered slight heterogeneity,25%<I~2<50%is moderate heterogeneity,and I~2>50%is high heterogeneity test.When the heterogeneity I~2 is less than 50%,we use the fixed effect model.When the heterogeneity is large and I~2 is greater than 50%,the random effect model is adopted.Results:1.In our results,we included a total of 8 case-control studies,all in English,involving 1316 patients.The NOS score of literature quality was≥6.2.The results of Meta analysis showed that among the data related to catheterization,4 studies compared the accidental removal rate between the TIVAP group and the PICC group.Firstly,the heterogeneity of the four studies was tested(I~2<25%),and there was no obvious heterogeneity between the studies,so the fixed effect model was adopted.The accidental catheter removal rate of the infusion port device group was compared with that of the PICC group(OR:0.531,95%CI,0.25-1.129P>0.05).The results showed that there was no significant statistical difference between the two groups.The catheter life span of the TIVAP group and the PICC group was compared in 4 studies.Firstly,the heterogeneity of the four studies was tested(I~2>50%).There was obvious heterogeneity between the studies,so the random effect model was used to compare the life span of the TIVAP group with that of the PICC group(SMD:1.742,95%CI,0.935-2.548).The results showed that there was no significant statistical difference between the two groups.3.The results of the study on the data related to catheter complications suggest that four studies compared the catheter occlusion events between the TIVAP group and the PICC group.Firstly,the heterogeneity of the four studies was tested(I~2<25%),and there was no significant heterogeneity between the studies,so the fixed effect model was adopted.The incidence of occlusive events in TIVAP group was significantly lower than that in PICC group(OR:0.11,95%CI,0.03-0.38P<0.05).The results showed that the incidence of occlusive events in TIVAP group was significantly lower than that in PICC group.Seven studies compared the catheter-related infections between the TIVAP group and the PICC group.Firstly,the heterogeneity of the seven studies was tested(I~2>50%).There was obvious heterogeneity between the studies,so the random effect model was used.The incidence of infection in TIVAP group was compared with that in PICC group(OR:1.008,95%CI,0.607-1.676,P>0.05),which showed that there was no significant difference between the two groups.Five studies compared the incidence of incorrect catheter placement between the TIVAP group and the PICC group.Firstly,the heterogeneity of the five studies was tested(I~2<25%),and there was no obvious heterogeneity between the studies,so the fixed effect model was adopted.The incidence of incorrect catheter placement in the TIVAP group and the PICC group was compared with that in the PICC group(OR:0.222,95%CI,0.076-0.647 P<0.05).The results showed that the incidence of incorrect placement of TIVAP was lower than that of PICC.Seven studies compared the incidence of catheter-related thrombosis between the TIVAP group and the PICC group.Firstly,the heterogeneity of the seven studies was tested(I~2<25%),and there was no significant heterogeneity between the studies,so the fixed effect model was adopted.The incidence of catheter-related thrombus in the TIVAP group was significantly higher than that in the PICC group(OR:0.252,95%CI,0.139-0.456,P<0.05).The results showed that the incidence of catheter-related thrombosis in TIVAP group was lower than that in PICC group.Three studies compared the catheter allergy rate between the TIVAP group and the PICC group.Firstly,the heterogeneity of the three studies was tested(I~2<25%),and there was no significant heterogeneity between the three studies,so the fixed effect model was used to compare the catheter allergy rate between the TIVAP group and the PICC group(OR:0.155,95%CI,0.035-0.696,P<0.05).The results showed that the catheter allergy rate in the TIVAP group was lower than that in the PICC group.Three studies compared the incidence of pain between the TIVAP group and the PICC group.Firstly,the heterogeneity of the three studies was tested(I~2<25%),and there was no significant heterogeneity between the studies,so the fixed effect model was used to compare the incidence of pain between the TIVAP group and the PICC group(OR:1.131,95%CI,0.419-3.056,P>0.05),I~2<25%,and there was no significant statistical difference.4.Three studies compared the catheter-related costs of TIVAP group and PICC group when the catheter maintenance time was less than 6months or 12 months.Firstly,the heterogeneity of the three studies was tested(I2>25%).The random effect model was used to compare the cost of TIVAP group and PICC group within 6 months(SMD:-1.574,95%CI,3.699-0.551,P>0.05).The results showed that there was no significant difference between the two groups.When the catheter was maintained for more than one year,the PICC group was compared with the TIVAP group(OR:9.84;95%CI,5.12-14.56 P<0.05).The results showed that the cost of the PICC group was much higher than that of the TIVAP group..Conclusion:According to our results,there was no significant difference in catheter lifespan and accidental removal rate between TIVAP and PICC in cancer patients.In comparing the complications of TIVAP and PICC,we found that the incidence of catheter occlusion,catheter misplacement,catheter-related thrombosis and catheter hypersensitivity in TIVAP was lower than that in PICC.There was no significant difference in catheter-related infection and pain between the two groups.There was no significant difference in 6-month catheter-related total cost between TIVAP and PICC,but the cost of TIVAP was lower in long-term treatment of more than one year.The results of this study provide a safe and feasible basis for cancer patients who need chemotherapy and total parenteral nutrition to choose PICC or TIVAP for long-term treatment via central vein.