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Published on: July 13, 2019
Pediatric Central Venous Access Device Lock Solutions: A Network Meta-analysis
Mari Takashima1,2,3, Yukiko Ezure4, Luis Furuya-Kanamori4
1School of Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, Queensland, Australia.
Insights
Chelating agents and antibiotic locks may prevent central venous access device (CVAD)-associated bloodstream infections in children. Thrombolytic agents can prevent CVAD occlusion, but ethanol may increase risks.
Area of Science:
- Pediatric critical care medicine
- Pharmacology
- Infectious disease prevention
Background:
- Central venous access devices (CVADs) are crucial in pediatric care but prone to complications.
- Lock solutions are routinely used to prevent and treat CVAD-related issues like infection, thrombosis, and occlusion.
Purpose of the Study:
- To systematically review and rank various lock solutions for preventing or treating CVAD complications in pediatric patients.
- To provide evidence-based recommendations for optimal lock solution selection.
Main Methods:
- A systematic review and network meta-analysis of randomized controlled trials (RCTs) was conducted.
- Searched five databases and two clinical trial registries for relevant studies.
- Extracted data on CVAD-associated bloodstream infection (BSI), thrombosis, occlusion, failure, and mortality.
Main Results:
- Chelating agents and antibiotic locks showed potential in preventing CVAD-associated BSI compared to heparinized saline.
- Preventative thrombolytic agents were associated with reduced odds of CVAD occlusion.
- Ethanol demonstrated increased odds of CVAD occlusion, while no solutions impacted thrombosis, CVAD failure, or mortality.
Conclusions:
- Chelating agents and antibiotic locks may be effective for preventing pediatric CVAD-associated BSI.
- Thrombolytic agents are a viable option for preventing CVAD occlusion.
- Ethanol is not recommended for CVAD lock solutions due to increased occlusion risk.
Context:
Central venous access device (CVAD) locks are routine interventions used to prevent and treat complications, such as infection, thrombosis, and catheter occlusion.
Objective:
To compare and rank lock-solutions for prevention or treatment of complications in pediatrics. Design Systematic review and network meta-analysis.
Data Sources:
Five databases and 2 clinical trial registries were searched.
Study Selection:
Published and unpublished randomized controlled trials that enrolled pediatric patients with a CVAD and compared the effectiveness of lock-solutions.
Data Extraction:
Data extraction was conducted by 2 reviewers. Odds ratio (OR) for prevention or treatment of CVAD-associated bloodstream infection (BSI), thrombosis, occlusion, CVAD-failure, and mortality were calculated, with point estimates ranking lock-solutions.
Results:
Twenty-nine studies were included. Chelating agents and antibiotic locks given as prevention were associated with lower odds (OR: 0.11; 95% confidence interval [CI]: 0.02-0.67; moderate-quality; OR: 0.19; 95% CI: 0.05-0.79, high-quality, respectively) of CVAD-associated BSI compared with heparinized saline (reference). Preventative thrombolytic agents had lower odds (OR: 0.64, 95% CI: 0.44-0.93; low-quality) of CVAD occlusion, whereas ethanol had higher odds (OR: 2.84, 95% CI: 1.31-6.16; high-quality) compared with heparinized saline (reference). No lock solution had effects on thrombosis prevention or treatment, CVAD-failure, CVAD-associated BSI treatment failure, or mortality.
Limitations:
There was substantial uncertainty around the point estimates because of the limited number of studies for outcomes and study heterogeneity. More high-quality studies are needed to confirm the efficacy of lock solutions.
Conclusions:
Chelating agents and antibiotic locks may be effective for CVAD-associated BSI prevention in pediatrics. Thrombolytic agents can be an option for CVAD occlusion prevention, whereas ethanol may not be recommended.
