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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.
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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