The Best Lock Solutions for Pediatric Central Venous Access Devices: A Network Meta-Analysis
Introduction:
Central venous access devices (CVADs) are essential in pediatric care, providing a reliable route for long-term treatments. However, they are also associated with risks such as infections, thrombosis, and catheter occlusions. This network meta-analysis evaluates various lock solutions used to prevent or treat these complications.
Background:
CVAD locks are routine interventions designed to maintain catheter patency and prevent complications. With multiple options available, determining the most effective lock solution for pediatric patients is crucial for enhancing care quality and reducing risks.
Objective:
This study compares and ranks different lock solutions used for preventing or treating CVAD-associated complications in pediatric patients, aiming to identify the most effective options.
Methods:
Data Sources: Five databases and two clinical trial registries were searched for relevant studies.
Study Selection: Included randomized controlled trials that enrolled pediatric patients with a CVAD and compared the effectiveness of different lock solutions.
Outcomes: The primary outcomes measured were CVAD-associated bloodstream infection (BSI), thrombosis, occlusion, CVAD failure, and mortality. Odds ratios (OR) were calculated to compare the effectiveness of the lock solutions.
Key Findings:
Chelating Agents and Antibiotic Locks: These were associated with significantly lower odds of CVAD-associated BSI compared with heparinized saline, with ORs of 0.11 and 0.19, respectively.
Thrombolytic Agents: Effective in preventing CVAD occlusion, with an OR of 0.64, indicating lower odds of occlusion compared to heparinized saline.
Ethanol Locks: Linked to higher odds of occlusion (OR: 2.84), suggesting it may not be recommended for preventing CVAD occlusion.
Other Findings: No lock solution showed significant effects on thrombosis prevention, CVAD failure, BSI treatment failure, or mortality.
Conclusion:
Chelating agents and antibiotic locks appear to be the most effective for preventing CVAD-associated BSIs in pediatric patients. Thrombolytic agents may be beneficial for occlusion prevention, while ethanol locks are less favorable. Further high-quality studies are needed to confirm these findings and optimize CVAD management in pediatric care.
Authors: Mari Takashima, Yukiko Ezure, Luis Furuya-Kanamori, Joshua Wolf, Mitchell Dufficy, Victoria Gibson, Julia Clark, Amanda Ullman
