title: Antimicrobial lock solutions for the prevention of catheter-related infection in patients undergoing haemodialysis: study protocol for network meta-analysis of randomised controlled trials.
abstract: BACKGROUND
  Catheter-related infection (CRI) is a difficult clinical problem in renal medicine, with blood stream infections occurring in up to 40% of patients with haemodialysis (HD) catheters, conferring significant rates of morbidity and mortality. Several approaches have been assessed as a means to prevent CRI. Currently, an intervention that is the source of much discussion is the use of antimicrobial lock solutions (ALS). A number of past conventional meta-analyses have compared different ALS with heparin. However, there is no consensus recommendation regarding which type of ALS is best. The purpose of our study is to carry out a network meta-analysis comparing the efficacy of different ALS for prevention of CRI in patients with HD and ranking these ALS for practical consideration.
  
  
  METHODS
  We will search six electronic databases, earlier relevant meta-analyses and reference lists of included studies for randomised controlled trials (RCTs) that compared ALS for preventing episodes of CRI in patients with HD either head-to-head or against control interventions using non-ALS. Study selection and data collection will be performed by two reviewers independently. The Cochrane Risk of Bias Tool will be used to assess the quality of included studies. The primary outcome of efficacy will be catheter-related bloodstream infection (CRBSI). We will perform a Bayesian network meta-analysis to compare the relative efficacy of different ALS by WinBUGS (V.1.4.3) and STATA (V.13.0). The quality of evidence will be assessed by GRADE.
  
  
  BACKGROUND
  Ethical approval is not required given that this study includes no confidential personal data and no data on interventions on patients. The results of this study will be submitted to a peer-review journal for publication.
  
  
  BACKGROUND
  CRD42015027010.
authors.affiliation: School of Nursing, Gansu University of Chinese Medicine, Lanzhou, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Zhang
authors.affiliation: School of Nursing, Gansu University of Chinese Medicine, Lanzhou, China.
authors.forename: Rong-Ke
authors.initials: RK
authors.lastname: Li
authors.affiliation: Department of Nursing, Taipei Municipal Wanfang Hospital, Taipei Medical University, Taipei, Taiwan Evidence-Based Knowledge Translation Center, Taipei Municipal Wanfang Hospital, Taipei Medical University, Taipei, Taiwan School of Nursing, Taipei Medical University, Taipei , Taiwan.
authors.forename: Kee-Hsin
authors.initials: KH
authors.lastname: Chen
authors.affiliation: Evidence-based Medicine Center of Lanzhou University, Lanzhou, China.
authors.forename: Long
authors.initials: L
authors.lastname: Ge
authors.affiliation: Evidence-based Medicine Center of Lanzhou University, Lanzhou, China.
authors.forename: Jin-Hui
authors.initials: JH
authors.lastname: Tian
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D055815:Young Adult; D000890:Anti-Infective Agents / Q000627:therapeutic use; D055499:Catheter-Related Infections / Q000517:prevention & control; D002405:Catheterization, Central Venous / Q000009:adverse effects; D002985:Clinical Protocols; D016032:Randomized Controlled Trials as Topic; D006435:Renal Dialysis; D016896:Treatment Outcome; D000071076:Network Meta-Analysis as Topic
chemical_list: D000890:Anti-Infective Agents
keywords: antimicrobial lock solution; catheter-related infection; central venous catheters; haemodialysis; network meta-analysis