Pediatric vascular access secured with tissue adhesive: Systematic review and meta-analysis

Area of Science:

• Pediatric vascular access device management
• Medical device security and complication reduction
• Wound closure and tissue adhesion technologies

Background:

• Vascular access devices (VADs) are crucial in pediatric care but prone to failure and complications.
• Tissue adhesive (TA) is explored as a method to secure VADs and prevent adverse events.
• Evidence on TA effectiveness in pediatric populations remains limited.

Purpose of the Study:

• To evaluate the efficacy of tissue adhesive (TA) in minimizing vascular access device (VAD) failure and associated complications in pediatric patients.
• To synthesize current evidence from randomized controlled trials (RCTs) on TA use for peripheral intravenous catheters (PIVCs) and central venous access devices (CVADs).

Main Methods:

• Systematic review and meta-analysis adhering to Cochrane guidelines and PRISMA standards.
• Searched six databases and three trial registries for RCTs (2007-2024) involving pediatric patients with TA-secured VADs.
• Assessed risk of bias (RoB2.0) and certainty of evidence (GRADE); meta-analyses used a common-effect model.

Main Results:

• Five studies (1030 children) included PIVCs and CVADs. TA significantly reduced PIVC failure (RR 0.66) and overall complications (RR 0.56) with low certainty evidence.
• TA also reduced PIVC dislodgement (RR 0.30). No significant benefits were found for CVADs.
• Evidence for PIVC outcomes was rated as very low to low certainty.

Conclusions:

• Tissue adhesive may be beneficial for securing PIVCs in children, reducing failure, complications, and dislodgement.
• No significant benefits were observed for central venous access devices (CVADs) in pediatric patients.
• Larger, standardized RCTs are necessary to confirm these findings and strengthen the evidence base.