Heparin-bonded catheters for prolonging the patency of central venous catheters in children.
BACKGROUND
Central venous catheters (CVCs) are a mainstay in the management of critically ill children. However, these catheters are associated with mechanical and infectious complications which reduce their life span. Heparin bonding of catheters has shown promise in animal studies and in adults.


OBJECTIVE
The primary objective was to determine the effect of heparin-bonded CVCs on the duration of catheter patency in children. Secondary objectives were to determine the effect of heparin-bonded catheters on catheter related thrombosis, occlusion, sepsis and side effects.


METHODS
We searched the Cochrane Peripheral Vascular Diseases (PVD) Group Trials Register (inception to August 2007) which contains trials identified through searches of MEDLINE (1966 to August 2007), EMBASE (1980 to August 2007), CINAHL (1982 to August 2007), and hand searches along with the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library 2007, Issue 3.


METHODS
We included randomised and quasi-randomised controlled trials of heparin-bonded catheters versus non-heparin bonded catheters or antibiotic-impregnated catheters that reported on any of the prespecified outcomes, without language restriction.


METHODS
Methodological quality of the trials was assessed using the information provided in the studies and by contacting authors. Data were extracted and the effect size was estimated and reported as relative risk (RR), risk difference (RD) or number needed to treat (NNT), as appropriate.


RESULTS
Two eligible studies reflecting 287 patients were included; both had good methodological quality. There was no difference in the duration of catheter patency between heparin bonded and non-heparin bonded catheters (median duration 7 days vs 6 days) reported in one study. There was no difference in the risk of catheter related thrombosis (RR 0.71, 95% CI 0.44 to 1.15; RD -0.05, 95% CI 0.13 to 0.02; I(2) = 79%). Data from one study revealed a statistically significant reduction in the risk of catheter occlusion (RR 0.06, 95% CI 0.00 to 1.07; RD -0.08, 95% CI -0.13 to -0.02; NNT 13, 95% CI 8 to 50), catheter-related infections (RR 0.06, 95% CI 0.01 to 0.41; RD -0.17, 95% CI -0.25 to -0.10; NNT 6, 95% CI 4 to 10) and catheter colonization (RR 0.21, 95% CI 0.06 to 0.71; RD -0.11, 95% CI -0.19 to -0.04; NNT 9, 95% CI 5 to 25) in the heparin-bonded catheter group.


CONCLUSIONS
Two eligible studies on the use of heparin-bonded catheters versus placebo in children were identified. The use of heparin-bonded catheters is a promising therapy but warrants further studies.
Shah
P S
PS
University of Toronto, Department of Paediatrics and Department of Health Policy, Management and Evaluation, Rm 775A, 600 University Avenue, Toronto, Ontario, Canada, M5G 1XB. pshah@mtsinai.on.ca
Shah
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D000293:Adolescent; D000925:Anticoagulants / Q000008:administration & dosage*; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000295:instrumentation*; D002648:Child; D002675:Child, Preschool; D006493:Heparin / Q000008:administration & dosage*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016032:Randomized Controlled Trials as Topic; D020246:Venous Thrombosis / Q000517:prevention & control*
D000925:Anticoagulants; D006493:Heparin