Heparin-bonded central venous lines reduce thrombotic and infective complications in critically ill children.
OBJECTIVE
To determine whether heparin bonding reduces the incidence of catheter-related thrombosis and infection in critically ill children.


METHODS
A prospective double-blind randomized controlled study.


METHODS
A tertiary paediatric intensive care unit.


METHODS
Two hundred and nine patients, 123 males and 86 females, aged 0-16 years, admitted to the intensive care unit and needing a central venous line (CVL), were randomized to receive either a heparin-bonded (HB, n = 102) or a non-heparin-bonded line (NHB, n = 107). Nine patients were excluded owing to incomplete data.


METHODS
HB or NHB CVL.


METHODS
Blood cultures were carried out on insertion of the line and every 3 days thereafter. Ultrasound was performed within the first 3 days and every 3 days thereafter. On removal the line was sent for culture.


RESULTS
The two groups were comparable for age, sex, severity of illness and length of time that the catheter was in situ. Proportional hazards modelling showed that heparin bonding was associated with a significant reduction in infections (hazard ratio 0.11, P < 0.00005). The incidence of infection was 4% and 33% in HB and NHB CVLs, respectively (4/97 vs. 34/103, P < 0.0005). The incidence of thrombosis was 0% and 8% in HB and NHB CVLs, respectively (0/97 vs. 8/103, P = 0.006). The number of HB CVLs which would need to be used to avoid one episode of infection or thrombosis was 3 and 13, respectively.


CONCLUSIONS
Our study shows a significant reduction in the incidence of infection and thrombosis associated with the use of HB CVLs.
Pierce
C M
CM
Paediatric Intensive Care Unit, Great Ormond Street Hospital for Children, London, UK. christine.pierce@gosh-tr.nthames.nhs.uk
Wade
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Mok
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D000293:Adolescent; D000925:Anticoagulants; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000295:instrumentation*; D002648:Child; D002675:Child, Preschool; D020099:Coated Materials, Biocompatible; D003428:Cross Infection / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D004311:Double-Blind Method; D005260:Female; D006493:Heparin; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D016015:Logistic Models; D008131:London / Q000453:epidemiology; D008297:Male; D011140:Polyurethanes; D016016:Proportional Hazards Models; D011446:Prospective Studies; D013927:Thrombosis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*
D000925:Anticoagulants; D020099:Coated Materials, Biocompatible; D011140:Polyurethanes; D006493:Heparin