title: Heparin-bonded catheters for prolonging the patency of central venous catheters in children.
abstract: 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. This is the first update of a review published in 2007.
  
  
  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 effects of heparin-bonded catheters on catheter-related thrombosis, occlusion, blood stream infection and side effects.
  
  
  METHODS
  For this update the Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator searched the Specialised Register (last searched August 2013) and CENTRAL (2013, Issue 7). The authors searched MEDLINE (1946 to week 3 August 2013).
  
  
  METHODS
  We included randomized and quasi-randomized 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
  We assessed the methodological quality of the trials using the information provided in the studies and by contacting authors. We extracted data and estimated the effect size reported as risk ratio (RR), risk difference (RD) or number needed to treat (NNT), as appropriate.
  
  
  RESULTS
  We included two eligible studies with a total of 287 participants; 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 seven days versus six days) reported in one study. There was no difference in the risk of catheter-related thrombosis (two studies, RR 0.34, 95% CI 0.01 to 7.68; I(2) = 80%; RD -0.06, 95% CI -0.17 to 0.06). 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 blood stream 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. The second study did not report on these outcomes. There was no significant difference in risk of thrombocytopenia after catheter placement (RR 0.73, 95% CI 0.38 to 1.39; RD -0.02, 95% CI -0.10 to 0.07).
  
  
  CONCLUSIONS
  Two eligible studies on the use of heparin-bonded catheters versus placebo in children were identified. Meta-analysis of the two studies revealed no reduction in catheter-related thrombosis with heparin-bonded catheters. One study reported a reduction in catheter-related blood stream infection and colonization following the use of heparin-bonded catheters. The strength of evidence is low and further well-designed multicenter randomized controlled trials are warranted.
authors.affiliation: Department of Paediatrics and Health Policy, Management and Evaluation, University of Toronto Mount Sinai Hospital, 600 University Avenue, Toronto, Ontario, Canada, M5G 1XB.
authors.forename: Prakeshkumar S
authors.initials: PS
authors.lastname: Shah
authors.forename: Niketa
authors.initials: N
authors.lastname: Shah
mesh_terms: D000293:Adolescent; D000925:Anticoagulants / Q000008:administration & dosage*; D055499:Catheter-Related Infections / Q000517:prevention & control; 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*
chemical_list: D000925:Anticoagulants; D006493:Heparin