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Infusión continua versus intermitente para la prevención de la pérdida de función de los catéteres intravenosos periféricos utilizados para la administración de fármacos en recién nacidos

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Referencias

References to studies included in this review

Ir a:

Kalyn 2000 {published data only}

Kalyn A, Blatz S, J Pinelli. A comparison of continuous infusion and intermittent flushing methods in peripheral intravenous catheters in neonates. Journal of IV Nursing 2000;23:146‐53.

Taylor 1989 {published data only}

Taylor J, Shannon R, Kilbride HW. Heparin lock intravenous line: use in newborn infants. Clinical Pediatrics 1989;28:237‐40.

References to studies excluded from this review

Ir a:

Danek 1992 {published data only}

Danek GD, Noris EM. Pediatric i.v. catheters: efficacy of saline flush. Pediatric Nursing 1992;18:111‐3.

Hanrahan 2000 {published data only}

Hanrahan KS, Kleiber C, Berends S. Saline for peripheral intravenous locks in neonates: evaluating change in practice. Neonatal Network 2000;19:19‐24.

LeDuc 1997 {published data only}

LeDuc K. Efficacy of normal saline solution versus heparin solution for maintaining patency of peripheral intravenous catheters in children. Journal of Emergency Nursing 1997;23:306‐9.

McMullen 1993 {published data only}

McMullen A, Fioravanti ID, Pollack V, Rideout K, Sciera M. Heparinized saline or normal saline as a flush solution in intermittent intravenous lines in infants and children. MCN. The American Journal of Maternal Child Nursing 1993;18:78‐85.

Nelson 1998 {published data only}

Nelson JJ, Graves SM. 0.9% Sodium chloride injection with and without heparin for maintaining peripheral indwelling intermittent‐infusion devices in infants. American Journal of Health‐System Pharmacy 1998;55:570‐3.

Additional references

Ir a:

Cotton 1998

Cotton MC, Turner BS, Miller‐Bell M. Pharmacology in neonatal care. In: Merenstein GB, Gardener SL editor(s). Handbook of Intensive Care. 5th Edition. St Louis: Mosby, 1998:148‐62.

Danek 1992

Danek GD, Noris EM. Pediatric i.v. catheters: efficacy of saline flush. Pediatric Nursing 1992;18:111‐3.

Dickersin 1994

Dickersin K, Scherer R, Lefebvre C. Identifying relevant studies for systematic reviews. British Medical Journal 1994;309:1286‐91.

Malcolm 2000

Malcom IL, Tudehope DI, Thearle MJ. Parent‐infant attachment and support for parents experiencing perinatal loss. In: Malcom IL, Tudehope DI, Thearle MJ editor(s). Essentials of neonatal medicine. 3rd Edition. Oxford: Blackwell Science, 2000:297‐303.

Moclair 1995

Moclair A, Bates I. The efficacy of heparin in maintaining peripheral infusions in neonates. European Journal of Pediatrics 1995;154:567‐70.

Olds 2000

Olds SB, London ML, Wieland Ladewig PA. The newborn at risk: conditions present at birth. In: Olds SB, London ML, Wieland Ladewig PA editor(s). Maternal‐newborn nursing: a family and community‐based approach. 6th Edition. New Jersey: Prentice Hall Health, 2000:804‐903.

Shah 2004

Shah PS, Ng E, Sinha AK. Heparin for prolonging peripheral intravenous catheter use in neonates. Cochrane Database of Systematic Reviews 2004, Issue 3. [DOI: 10.1002/14651858.CD002774.pub2]

Ward 1993

Ward R M. Neonatal pharmocology. In: Kenner C, Brueggemeyer A, Gunderson LP editor(s). Comprehensive neonatal nursing. 1st Edition. Philadelphia: W.B.Saunders Company, 1993:926‐939.

WHO 1998

Anonymous. Evidence for the ten steps to successful breastfeeding. Revised. Geneva: World Health Organisation, 1998.

Yeo 1998

Yeo H. Stress in the neonatal unit. In: Yeo H editor(s). Nursing the Neonate. Oxford: Blackwell Science, 1998:278‐92.

Characteristics of studies

Characteristics of included studies [ordered by study ID]

Ir a:

Kalyn 2000

Methods

Multi‐centre randomised controlled trial with treatment group allocation determined by computer generated randomisation.

Assessment of the following key criteria:
allocation concealment (blinding of randomisation) ‐ yes, group allocation was concealed by opaque envelopes;
blinding of intervention ‐ no;
completeness of follow up ‐ all infants that entered the study were accounted for;
blinding of outcome measurement ‐ no.

Participants

Neonates in the neonatal nursery who do not require IV fluids.

Number of infants = 95
‐IF=42
‐CI=53

Number of catheters = 238
‐154 in CI
‐84 in IF

Interventions

Continuous infusion (CI) using 0.5‐1 mL of 10% Dextrose; or
intermittent flushing (IF) using 0.5‐1 mL 0.9% normal saline flushed before and after every medication and every 6 hours.

Outcomes

Proportion of catheters with:
1. infiltration, phlebitis or leaking;
2. occlusion;
3. either removal because intravenous medication was stopped, the infant was transferred elsewhere or the infant required maintenance intravenous fluids.

Notes

The infants were randomised and allocated to either group, but the data were analysed and reported by catheter.

The lead author of this study was contacted for further information regarding this study: additional data were available on the duration of patency for the first catheter used per infant.

Risk of bias

Bias

Authors' judgement

Support for judgement

Allocation concealment?

Low risk

A ‐ Adequate
Taylor 1989

Methods

Randomised controlled trial. The randomisation method was not stated.

Assessment of the following key criteria:
allocation concealment (blinding of randomisation) ‐ yes, group allocation was concealed by opaque envelopes;
blinding of intervention ‐ no;
completeness of follow up ‐ all infants that entered the study were accounted for;
blinding of outcome measurement ‐ no.

Participants

Newborn infants who were admitted to the 'intermediate care' nursery who either 1. required intravenous medications but no additional intravenous fluids, or 2. had an umbilical arterial catheter in situ and required an intravenous cannula for medications.

Number of infants = 39
‐IF=22
‐CI=17

Interventions

Continuous infusion (CI) using 10% dextrose (without heparin) at a rate of 1.5 to 3.0 ml/hr; or
intermittent flushing (IF) using a heparin lock (0.5 ml of heparinised saline) given every 6 hours or after injection of medications.

Outcomes

Outcome measures included:
the number of days the infant was enrolled in the study;
quantitation of parental medications, blood products and intravenous fluids;
number of line infiltrations;
duration of cannula patency (this seemed to have been measured for each cannula regardless of the number used in each infant); and
the number of times the infant was removed from the incubator to be held by a nurse or parent.

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Allocation concealment?

Low risk

A ‐ Adequate

Abbreviations
CI‐continuous infusion
IF‐intermittent infusion

Characteristics of excluded studies [ordered by study ID]

Ir a:

Study

Reason for exclusion

Danek 1992

Did not compare continuous infusion with intermittent flushes.

Hanrahan 2000

Historical cohort comparison only; did not compare continuous infusion with intermittent flushes.

LeDuc 1997

Did not compare continuous infusion with intermittent flushes.

McMullen 1993

Did not compare continuous infusion with intermittent flushes.

Nelson 1998

Did not compare continuous infusion with intermittent flushes.

Data and analyses

Open in table viewer
Comparison 1. Continuous infusion versus intermittent flushing

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Duration of cannula patency for the first cannula used per infant (hours) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected
Analysis 1.1
Comparison 1 Continuous infusion versus intermittent flushing, Outcome 1 Duration of cannula patency for the first cannula used per infant (hours).

Comparison 1 Continuous infusion versus intermittent flushing, Outcome 1 Duration of cannula patency for the first cannula used per infant (hours).

2 Number of cannulas used per infant in the first 48 hours Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected
Analysis 1.2
Comparison 1 Continuous infusion versus intermittent flushing, Outcome 2 Number of cannulas used per infant in the first 48 hours.

Comparison 1 Continuous infusion versus intermittent flushing, Outcome 2 Number of cannulas used per infant in the first 48 hours.

Comparison 1 Continuous infusion versus intermittent flushing, Outcome 1 Duration of cannula patency for the first cannula used per infant (hours).
Figuras y tablas -
Analysis 1.1

Comparison 1 Continuous infusion versus intermittent flushing, Outcome 1 Duration of cannula patency for the first cannula used per infant (hours).

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Comparison 1 Continuous infusion versus intermittent flushing, Outcome 2 Number of cannulas used per infant in the first 48 hours.
Figuras y tablas -
Analysis 1.2

Comparison 1 Continuous infusion versus intermittent flushing, Outcome 2 Number of cannulas used per infant in the first 48 hours.

Ir a la figura de la revisiónAbrir en una pestaña nueva
Comparison 1. Continuous infusion versus intermittent flushing

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Duration of cannula patency for the first cannula used per infant (hours) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

2 Number of cannulas used per infant in the first 48 hours Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected
Figuras y tablas -
Comparison 1. Continuous infusion versus intermittent flushing
Ir a la tabla de la revisión