Influencing factors of neonatal peripherally inserted central venous catheter (PICC)-related phlebitis: a systematic review, meta-analysis and network meta-analysis

A peripherally inserted central venous catheter (PICC) plays an important role in the security of newborns, especially very low birth weight infants and extremely very low birth weight infants. However, PICC-related phlebitis can seriously affect the normal use of catheters and even cause unplanned removals of catheters. In this review, we systematically reviewed and explored the influencing factors of neonatal PICC-related phlebitis. The PubMed, Embase, CENTRAL, CINAHL, CBM, Wanfang and CNKI databases were searched to collect relevant studies on influencing factors of neonatal PICC-related phlebitis. Review Manager software version 5.3 (RevMan; the Cochrane Collaboration 2012, The Nordic Cochrane Center, Copenhagen, Denmark) and GeMTC software version 0.14.3 (Gert van Valkenhoef, Groningen, The Netherlands ) were used for the meta-analysis and network meta-analysis. A total of 32 studies were included, including 14 randomized controlled trials (RCTs), 2 case-control studies, and 16 cohort studies, involving a total of 8278 neonates. The meta-analysis results showed that the influencing factors of neonatal PICC-related phlebitis were catheter malposition (OR (Odds Ratio) = 5.53, 95% CI (Confidence Interval) (1.22, 25.15)), catheter occlusion (OR = 7.18, 95% CI (3.54, 14.56)), gestational age (OR = 2.51, 95% CI (1.35, 4.66)), using a dexamethasone solution to infiltrate the catheter (OR = 0.26, 95% CI (0.17, 0.41)), and innovative nursing interventions (OR = 0.17, 95% CI (0.07, 0.42)). The network meta-analysis results showed that, compared with lower limb veins, the use of scalp veins (OR = 3.57, 95% CI (1.39, 10.18)) and upper limb veins (OR = 1.89, 95% CI (1.08, 3.37)) had a statistically significant difference in the incidence of phlebitis, while there was no statistically significant difference in the incidence of phlebitis between scalp veins and upper limb veins (OR = 0.53, 95% CI (0.20, 1.26)). PICC puncture of the lower limb veins was most likely to lead to phlebitis, followed by upper limb vein puncture, followed by scalp vein puncture. Catheter malposition, catheter occlusion and being small for gestational age were risk factors for PICC-related phlebitis, while dexamethasone solution infiltration of catheters and innovative nursing interventions were protective factors. Venipuncture of the lower limbs is the most likely location to cause PICC-related phlebitis.