Comparative Efficacy and Safety of Lock Solutions for the Prevention of Catheter-Related Bloodstream Infections: A Systematic Review and Network Meta-Analysis
53 Pages Posted: 18 Apr 2019More...
Background: Central venous catheters are still used extensively as temporary or permanent blood access for hemodialysis patients. Catheter-related bloodstream infections are the main complication of central venous catheters and increase morbidity and mortality in hemodialysis patients. However, the most appropriate lock solution for central venous catheters to prevent catheter-related bloodstream infections is still uncertain.
Methods: Medline, Embase and Cochrane Central Register of Controlled Trials were systematically searched up to August 2018. The reference lists of eligible studies and relevant reviews were also checked. The primary outcomes were catheter-related bloodstream infections and bleeding events. The secondary outcomes were catheter malfunction, exit-site infection, and all-cause mortality.
Findings: 50 trials (7142 patients) were included for this study. Compared with heparin 5000U/ml, antibiotic locks (antibiotics with TSC, EDTA, heparin 5000U/ml, low-dose heparin, or urokinase) and ethanol locks were more effective in preventing catheter-related bloodstream infections. Antimicrobial agents plus low-dose heparin (500-2500 U/ml), TSC and low-dose heparin locks had lower risk of bleeding events than heparin 5000 U/ml. No lock solution reduced rates of catheter malfunction and all-cause mortality compared with heparin 5000 U/ml. In summary, antibiotics plus low-dose heparin was ranked as the best lock solution. The overall results were not materially changed in sensitivity analyses.
Interpretation: Taking into account both efficacy and safety, antibiotics plus low-dose heparin (500-2500 U/ml) may be the preferred lock solution.
Funding: Chinese Special Funds for Scientific Research on Public Causes (201502010).
Declaration of Interest: We declare no competing interests.
Keywords: catheter-related bloodstream infections; hemodialysis; central venous catheters
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