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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 2019

See all articles by Kaixiang Sheng

Kaixiang Sheng

Zhejiang University - Kidney Disease Center

Ping Zhang

Zhejiang University - Kidney Disease Center

Jiawei Li

Zhejiang University - Kidney Disease Center

Jun Cheng

Zhejiang University - Kidney Disease Center

Yongchun He

Zhejiang University - Kidney Disease Center

Maristela Böhlke

Catholic University of Pelotas

Jianghua Chen

Zhejiang University - Kidney Disease Center; Key Laboratory of Kidney Disease Prevention and Control Technology; Zhejiang University - Institute of Nephrology

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Abstract

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

Suggested Citation

Sheng, Kaixiang and Zhang, Ping and Li, Jiawei and Cheng, Jun and He, Yongchun and Böhlke, Maristela and Chen, Jianghua, Comparative Efficacy and Safety of Lock Solutions for the Prevention of Catheter-Related Bloodstream Infections: A Systematic Review and Network Meta-Analysis (April 16, 2019). Available at SSRN: https://ssrn.com/abstract=3373855

Kaixiang Sheng

Zhejiang University - Kidney Disease Center

Qingchun Road 79
Hangzhou, 310003
China

Ping Zhang

Zhejiang University - Kidney Disease Center

Qingchun Road 79
Hangzhou, 310003
China

Jiawei Li

Zhejiang University - Kidney Disease Center

Qingchun Road 79
Hangzhou, 310003
China

Jun Cheng

Zhejiang University - Kidney Disease Center

Qingchun Road 79
Hangzhou, 310003
China

Yongchun He

Zhejiang University - Kidney Disease Center

Qingchun Road 79
Hangzhou, 310003
China

Maristela Böhlke

Catholic University of Pelotas

Pelotas
Brazil

Jianghua Chen (Contact Author)

Zhejiang University - Kidney Disease Center ( email )

Qingchun Road 79
Hangzhou, 310003
China

Key Laboratory of Kidney Disease Prevention and Control Technology ( email )

China

Zhejiang University - Institute of Nephrology ( email )

China

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