Peripherally inserted central catheters versus central venous catheters in critically ill patients under standardized insertion protocols: a propensity score-matched cohort study.

BACKGROUND

The safety of peripherally inserted central catheters (PICCs) in critically ill patients remains controversial, particularly regarding the risk of thrombosis and infection compared with centrally inserted central venous catheters (CVCs). With the adoption of contemporary vascular access techniques and standardized insertion protocols, the complication profile of these devices may have changed.

METHODS

We conducted a retrospective cohort study including adult ICU patients who underwent PICC or CVC placement between January 2023 and December 2024. All insertions followed standardized protocols (Safe Insertion of PICCs and Safe Insertion of Central Venous Catheters). Propensity score matching (1:2) was performed to balance baseline characteristics. Primary outcomes were symptomatic deep vein thrombosis (DVT) and central line-associated bloodstream infection (CLABSI). Secondary outcomes included catheter dislodgement and occlusion.

RESULTS

A total of 250 patients were included, and 214 remained after propensity score matching (81 PICC vs. 133 CVC). Symptomatic DVT occurred in 2.5% of PICC patients and 3.0% of CVC patients. The corresponding incidence rates were 2.16 and 2.68 events per 1,000 catheter-days, respectively. CLABSI occurred in 2.5% and 2.3% of patients, corresponding to 2.16 and 2.01 events per 1,000 catheter-days, respectively. Because the number of outcome events was small, these estimates were associated with substantial statistical uncertainty.

CONCLUSIONS

In this single-center matched cohort, no statistically significant differences in symptomatic DVT or CLABSI were observed between PICCs and CVCs. However, the small number of outcome events limited statistical power. These findings should be interpreted as exploratory and hypothesis-generating rather than as evidence of equivalence between catheter types.