Complications of Central Venous Access Devices Used in Palliative Care Settings for Terminally Ill Cancer Patients: A Systematic Review and Meta-Analysis

SIMPLE SUMMARY: Common central venous access devices (CVADs) include peripherally inserted central catheters (PICCs), central lines, and totally implanted ports (PORTs). Studies have shown PORTs have the least catheter-related complications, while PICCs are associated with the highest risk. The delivery of systemic anticancer therapy is known to be a risk factor in CVAD-related complications. Little is known about the complication profile of each CVAD when it is used for purely palliative intent without systemic anticancer therapy. We performed a systematic review and meta-analysis evaluate the complication rates of different types of CVADs used in palliative care settings. The use of central lines in terminally ill cancer patients was found to have fewer complications than PICCs in terms of overall complications, catheter-related bloodstream infection, and thromboembolism. No conclusion can be made on PORTs due to a lack of publications. As there are currently no clinical guidelines regarding the choice of CVAD in terminally ill cancer patients, our study summarizes the current available evidence to provide a basis for further studies on this important issue. ABSTRACT: (1) Background: Central venous access devices (CVADs) have been commonly employed during various courses of anticancer treatment. Currently, there are a few types of clinically available CVADs, which are associated with short-term and long-term complications. However, little is known about the complication rates when CVADs are used only in palliative care settings. We therefore performed a systematic review and meta-analysis of all the published literature to evaluate the complication rates of CVADs in this clinical setting. (2) Methods: A systematic review and meta-analysis were conducted to identify publications from PubMed/MEDLINE, Embase (Ovid), Scopus, Cochrane Library, CINAHL, Google Scholar, and trial registries. Publications reporting the complication rates of PICCs, central lines, and PORTs in palliative settings for terminally ill cancer patients were included, while those on the use of systemic anticancer therapy and peripheral venous catheters were excluded. The outcome measures included overall complication rate, rate of catheter-related bloodstream infection (CRBSI), and rate of thromboembolism (TE). This systematic review was registered with PROSPERO (CRD42023404489). (3) Results: Five publications with 327 patients were analyzed, including four studies on PICCs and one study on central lines. No studies on PORTs were eligible for analysis. The overall complication rate for PICCs (pooled estimate 7.02%, 95% CI 0.27–19.10) was higher than that for central lines (1.44%, 95% CI 0.30–4.14, p = 0.002). The risk of CRBSI with PICCs (2.03%, 95% CI 0.00–9.62) was also higher than that with central lines (0.96%, 95% CI 0.12–3.41, p = 0.046). PICCs also had a trend of a higher risk of TE (2.10%, 95% CI 0.00–12.22) compared to central lines (0.48%, 95% CI 0.01–2.64, p = 0.061). (4) Conclusions: PICCs for palliative cancer care were found to have greater complications than central lines. This might aid in the formulation of future recommendation guidelines on the choice of CVAD in this setting.