A systematic review and network meta-analysis of randomized controlled trials on choice of central venous access device for delivery of chemotherapy

Ensuring reliable central venous access with the fewest complications is vital for cancer patients receiving chemotherapy. A systematic review and network meta-analysis was conducted to compare the safety, quality of life, and cost-effectiveness of different types of central venous access devices (CVADs) for patients receiving chemotherapy.The PubMed, EMBASE, and Cochrane databases were searched from inception to August 20, 2021 for randomized controlled trials comparing the various CVADs (ie, nontunneled central venous catheters [CVCs], peripherally inserted CVCs [PICCs], totally implantable venous access ports [TIVAPs], and tunneled CVCs).A total of 11 eligible randomized controlled trials of 2585 patients were identified. TIVAPs were associated with a lower odds of overall complications, device removal due to complications, and thrombotic and mechanical complications compared with PICCs (odds ratio [OR], 0.54; 95% confidence interval [CI], 0.43-0.69; OR, 0.49; 95% CI 0.26-0.93; OR, 0.37; 95% CI, 0.23-0.62; and OR, 0.35; 95% CI, 0.13-0.95, respectively). Tunneled CVCs were associated with a higher odds of overall complications, device removal due to complications, and infective complications compared with TIVAPs (OR, 1.68; 95% CI, 1.30-2.17; OR, 2.52; 95% CI, 1.34-4.73; and OR, 2.11; 95% CI, 1.14-3.90, respectively). The ranking probability using the surface under the cumulative ranking curve values indicated that TIVAPs had the lowest probability of overall complications, removal due to complications, and thrombotic complications.TIVAPs were found to be superior in terms of complications and quality of life compared with other CVADs, without compromising cost-effectiveness, and should be considered the standard of care for patients receiving chemotherapy.