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Pediatric vascular access secured with tissue adhesive: Systematic review and meta-analysis
Sabrina de Souza1, Mari Takashima2, Elouise Comber2
1The University of Queensland, Brisbane, (QLD), Australia; Children's Health Queensland Hospital and Health Service, Brisbane, (QLD), Australia; Universidade Federal de Santa Catarina, Florianopolis, (SC), Brazil.
Insights
Tissue adhesive (TA) may reduce failure, complications, and dislodgement for peripheral intravenous catheters (PIVCs) in children. However, TA showed no benefit for central venous access devices (CVADs).
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.
Aim:
Evaluate the effectiveness of tissue adhesive (TA) in reducing vascular access device failure and complications in pediatrics.
Methods:
We conducted a systematic review with meta-analysis, following Cochrane guidelines and PRISMA standards. Six databases and three trial registries were searched for randomized controlled trials (RCTs) published between 2007 and 2024. Eligible studies included pediatric patients (post-neonatal discharge to <18years) with peripheral or central venous access devices (CVADs) secured with TA. Two reviewers independently screened studies and extracted data, with a third resolving conflicts. Risk of bias was assessed through RoB2.0, and certainty of evidence through Grading of Recommendations Assessment, Development and Evaluation (GRADE). Primary outcome was device failure; secondary included overall and individual complications, hemostasis, life of first dressing, catheter dwell time, and staff/caregiver acceptability. Meta-analyses used a common-effect model to calculate pooled risk ratios (RR) and incidence rate ratios (IRR).
Protocol Registration:
CRD42024558209.
Results:
Five studies (3 CVADs, 2 Peripheral Intravenous Catheters [PIVCs]; 1030 children) were included. For PIVCs, TA reduced failure (RR = 0.66; 95%CI:0.50-0.87; I2 = 80%,τ2 = 0.20,p = 0.02), though IRR was not significant (IRR = 0.73; 95%CI:0.53-1.01; I2 = 69%,τ2 = 0.14,p = 0.07); both GRADE rated as very low certainty evidence. TA significantly reduced overall complications (RR = 0.56; 95% CI:0.47-0.67; I2 = 0%,τ2 = 0,p = 0.74 vs IRR = 0.62; 95% CI:0.48-0.80; I2 = 0%,τ2 = 0,p = 0.98), and dislodgement (RR = 0.30; 95% CI:0.12-0.76,I2 = 17%, τ2 = 0.08,p = 0.27 vs IRR = 0.31; 95% CI:0.13-0.74; I2 = 0%,τ2 = 0, p = 0.32); both GRADE rated as low certainty. No significant associations were detected for CVADs.
Conclusions:
TA may reduce failure, overall complications and dislodgement for PIVCs in children, but no benefit was observed for CVADs. Larger RCTs using standardized methods are needed to strengthen the evidence.
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