Heparin‐bonded catheters for prolonging the patency of central venous catheters in children

Prakeshkumar S Shah; Niketa Shah

doi:10.1002/14651858.CD005983.pub2

Heparin‐bonded catheters for prolonging the patency of central venous catheters in children

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Referencias

References to studies included in this review

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estudios excluidos
otras referencias

Anton N, Cox P, Massicotte P, Dinyari M, Vegh P, Mitchell LG. No difference in incidences of thrombosis between heparin bonded catheters and non heparin bonded catheters in Infants in the critical care unit following surgery for congenital heart disease: a randomised controlled triple blind study. Journal of Thrombosis and Haemostasis 2005;3:Abstract # P1726.

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Pierce CM, Wade A, Mok Q. Heparin‐bonded central venous lines reduce thrombotic and infective complications in critically ill children. Intensive Care Medicine 2000;26(7):967‐72.

References to studies excluded from this review

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estudios incluidos
otras referencias

Appelgren P, Ransjo U, Bindslev L, Espersen F, Larm O. Surface heparinization of central venous catheters reduces microbial colonization in vitro and in vivo: results from a prospective, randomized trial. Critical Care Medicine 1996;24(9):1482‐9.

Bennegard K, Curelaru I, Gustavsson B, Linder LE, Zachrisson BF. Material thrombogenicity in central venous catheterization. I. A comparison between uncoated and heparin‐coated, long antebrachial, polyethylene catheters. Acta Anaesthesiologica Scandinavica 1982;26(2):112‐20.

Carrasco MN, Bueno A, de las Cuevas C, Jimenez S, Salinas I, Sartorius A, et al. Evaluation of a triple‐lumen central venous heparin‐coated catheter versus a catheter coated with chlorhexidine and silver sulfadiazine in critically ill patients. Intensive Care Medicine 2004;30(4):633‐8.

Hoar PF, Wilson RM, Mangano DT, Avery GJ, Szarnicki RJ, Hill JD. Heparin bonding reduces thrombogenicity of pulmonary‐artery catheters. New England Journal of Medicine 1981;305(17):993‐5.

Krafte‐Jacobs B, Sivit CJ, Mejia R, Pollack MM. Catheter‐related thrombosis in critically ill children: Comparison of catheters with and without heparin bonding. Journal of Pediatrics 1995;126(1):50‐4.

Mangano DT. Heparin bonding and long‐term protection against thrombogenesis. New England Journal of Medicine 1982;307(14):894‐895.

Additional references

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estudios incluidos
estudios excluidos

Abdelkefi A, Ben Othman T, Kammoun L, Chelli M, Romdhane NB, Kriaa A, et al. Prevention of central venous line‐related thrombosis by continuous infusion of low‐dose unfractionated heparin, in patients with haemato‐oncological disease. A randomized controlled trial. Thrombosis and Haemostasis 2004;92(3):654‐61.

Andrew M, David M, Adams M, Ali K, Anderson R, Barnard D, et al. Venous thromboembolic complications (VTE) in children: first analyses of the Canadian Registry of VTE. Blood 1994;83(5):1251‐7.

Bailey MJ. Reduction of catheter‐associated sepsis in parenteral nutrition using low‐dose intravenous heparin. British Medical Journal 1979;1(6179):1671‐3.

Beck C, Dubois J, Grignon A, Lacroix J, David M. Incidence and risk factors of catheter‐related deep vein thrombosis in a pediatric intensive care unit: a prospective study. Journal of Pediatrics 1998;133(2):237‐41.

Brismar B, Hardstedt C, Jacobson S, Kager L, Malmborg AS. Reduction of catheter‐associated thrombosis in parenteral nutrition by intravenous heparin therapy. Archives of Surgery 1982;117(9):1196‐9.

de Neef M, Heijboer H, van Woensel JB, de Haan RJ. The efficacy of heparinization in prolonging patency of arterial and central venous catheters in children: a randomized double‐blind trial. Pediatric Hematology and Oncology 2002;19(8):553‐60.

Di Costanzo J, Sastre B, Choux R, Reynier JP, Noirclerc M, Cano N, et al. Experimental approach to prevention of catheter‐related central venous thrombosis. Journal of Parenteral and Enteral Nutrition 1984;8(3):293‐7.

Gilbert R, Howard R, Mok Q. Heparin‐bonded lines reduce hospital‐acquired bacteraemia. Journal of Hospital Infection 2003;54(2):163‐4.

Hofbauer R, Moser D, Kaye AD, Dielacher C, Hornykewycz S, Handler S, et al. Thrombus formation on the balloon of heparin‐bonded pulmonary artery catheters: an ultrastructural scanning electron microscope study. Critical Care Medicine 2000;28(3):727‐35.

Jacobs BR, Barr LL, Brilli RJ, Lyons KA, Wong HR. Intracatheter nitroglycerin infusion fails to prevent catheter‐related venous thrombosis: a randomized, controlled trial. Intensive Care Medicine 2001;27(1):187‐92.

Klerk CP, Smorenburg SM, Buller HR. Thrombosis prophylaxis in patient populations with a central venous catheter: a systematic review. Archives of Internal Medicine 2003;163(16):1913‐21.

Marin MG, Lee JC, Skurnick JH. Prevention of nosocomial bloodstream infections: effectiveness of antimicrobial‐impregnated and heparin‐bonded central venous catheters. Critical Care Medicine 2000;28(9):3332‐8.

Massicotte MP, Dix D, Monagle P, Adams M, Andrew M. Central venous catheter related thrombosis in children: analysis of the Canadian Registry of Venous Thromboembolic Complications. Journal of Pediatrics 1998;133(6):770‐6.

Mollenholt P, Eriksson I, Andersson T. Thrombogenicity of pulmonary‐artery catheters. Intensive Care Medicine 1987;13(1):57‐9.

Nichols AB, Owen J, Grossman BA, Marcella JJ, Fleisher LN, Lee MM. Effect of heparin bonding on catheter‐induced fibrin formation and platelet activation. Circulation 1984;70(5):843‐50.

Rabe C, Gramann T, Sons X, Berna M, Gonzalez‐Carmona MA, Klehr HU, et al. Keeping central venous lines open: a prospective comparison of heparin, vitamin C and sodium chloride sealing solutions in medical patients. Intensive Care Medicine 2002;28(8):1172‐6.

Randolph AG, Cook DJ, Gonzales CA, Andrew M. Benefit of heparin in central venous and pulmonary artery catheters: a meta‐analysis of randomized controlled trials. Chest 1998;113(1):165‐71.

Schmugge M, Risch L, Huber AR, Benn A, Fischer JE. Heparin‐induced thrombocytopenia‐associated thrombosis in pediatric intensive care patients. Pediatrics 2002;109(1):E10.

Timsit JF, Farkas JC, Boyer JM, Martin JB, Misset B, Renaud B, et al. Central vein catheter‐related thrombosis in intensive care patients: incidence, risks factors, and relationship with catheter‐related sepsis. Chest 1998;114(1):207‐13.

Warkentin TE, Kelton JG. Heparin and platelets. Hematology ‐ Oncology Clinics of North America 1990;4(1):243‐64.

Characteristics of studies

Characteristics of included studies [ordered by study ID]

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estudios excluidos

Anton 2005

Methods	Randomized controlled trial I. Masking of randomization ‐ Cannot tell II. Masking of intervention ‐ Yes III. Masking of outcome assessment ‐ Yes IV. Completeness of follow up ‐ No
Participants	Inclusion criteria: Children < 1 year of age who had congenital heart disease and needed central venous catheter access N = 86; 41 females, 46 males Mean age: 5.0 ± 3.2 months (SD)
Interventions	Group 1: Heparin‐bonded central venous catheter Group 2: Non heparin‐bonded central venous catheter
Outcomes	Catheter‐related thrombosis
Notes
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	B ‐ Unclear

Pierce 2000

Methods	Randomized controlled trial I. Masking of randomization ‐ Yes II. Masking of intervention ‐ Yes III. Masking of outcome assessment ‐ Yes IV. Completeness of follow up ‐ No
Participants	Inclusion criteria: Children aged 1 day to 16 years of age who were ventilated and needed central venous catheter access Exclusion criteria: Patients with history of recent use of central venous catheter (within the last month), patients on thrombolytic therapy, patients with history of thrombosis, and post‐operative cardiac patients Group 1: 102 randomized patients (97 patients had complete data and included in the analyses) Age: 17 patients < 28 days 80 patients > 28 days of age N = 97 (56 males, 41 females) Size of catheter 4F:5F = 17:80 Site of catheter Femoral:Neck = 80:17 Group 2: 107 patients randomized (103 patients had complete data and included in the analyses) Age: 17 patients < 28 days 80 patients > 28 days N = 103 (55 males, 48 females) Size of catheter 4F:5F = 24:79 Site of catheter Femoral:Neck = 90:13
Interventions	Group 1: Heparin‐bonded central venous catheter Group 2: Non heparin‐bonded central venous catheter
Outcomes	Catheter‐related infection Catheter colonization Catheter‐related thrombosis Catheter occlusion Duration of catheter patency Thrombocytopenia
Notes
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Low risk	A ‐ Adequate

SD = standard deviation

Characteristics of excluded studies [ordered by study ID]

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estudios incluidos

Study	Reason for exclusion
Appelgren 1996	Adult population only
Bennegard 1982	Adult population only
Carrasco 2004	Adult population only
Hoar 1981	Adult population only
Krafte‐Jacobs 1995	Not a randomized study Prospective comparison of two types of catheters
Mangano 1982	Adult population only

Data and analyses

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Comparison 1. Heparin bonded catheter versus non‐heparin bonded catheters

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Catheter‐related thrombosis at any time during catheter stay Show forest plot	2	287	Risk Ratio (M‐H, Fixed, 95% CI)	0.71 [0.44, 1.15]
Open in figure viewer Analysis 1.1 Comparison 1 Heparin bonded catheter versus non‐heparin bonded catheters, Outcome 1 Catheter‐related thrombosis at any time during catheter stay.
2 Catheter‐related thrombosis within one week of catheter insertion Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected
Open in figure viewer Analysis 1.2 Comparison 1 Heparin bonded catheter versus non‐heparin bonded catheters, Outcome 2 Catheter‐related thrombosis within one week of catheter insertion.
3 Catheter‐related thrombosis after one week of insertion Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected
Open in figure viewer Analysis 1.3 Comparison 1 Heparin bonded catheter versus non‐heparin bonded catheters, Outcome 3 Catheter‐related thrombosis after one week of insertion.
4 Occlusion of catheter within one week of catheter insertion Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected
Open in figure viewer Analysis 1.4 Comparison 1 Heparin bonded catheter versus non‐heparin bonded catheters, Outcome 4 Occlusion of catheter within one week of catheter insertion.
5 Occlusion of catheter after one week of catheter insertion Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected
Open in figure viewer Analysis 1.5 Comparison 1 Heparin bonded catheter versus non‐heparin bonded catheters, Outcome 5 Occlusion of catheter after one week of catheter insertion.
6 Catheter‐related infection Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected
Open in figure viewer Analysis 1.6 Comparison 1 Heparin bonded catheter versus non‐heparin bonded catheters, Outcome 6 Catheter‐related infection.
7 Colonization of catheter with microbes Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected
Open in figure viewer Analysis 1.7 Comparison 1 Heparin bonded catheter versus non‐heparin bonded catheters, Outcome 7 Colonization of catheter with microbes.
8 Thrombocytopenia after catheter insertion Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected
Open in figure viewer Analysis 1.8 Comparison 1 Heparin bonded catheter versus non‐heparin bonded catheters, Outcome 8 Thrombocytopenia after catheter insertion.

Analysis 1.1

Comparison 1 Heparin bonded catheter versus non‐heparin bonded catheters, Outcome 1 Catheter‐related thrombosis at any time during catheter stay.

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Analysis 1.2

Comparison 1 Heparin bonded catheter versus non‐heparin bonded catheters, Outcome 2 Catheter‐related thrombosis within one week of catheter insertion.

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Analysis 1.3

Comparison 1 Heparin bonded catheter versus non‐heparin bonded catheters, Outcome 3 Catheter‐related thrombosis after one week of insertion.

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Analysis 1.4

Comparison 1 Heparin bonded catheter versus non‐heparin bonded catheters, Outcome 4 Occlusion of catheter within one week of catheter insertion.

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Analysis 1.5

Comparison 1 Heparin bonded catheter versus non‐heparin bonded catheters, Outcome 5 Occlusion of catheter after one week of catheter insertion.

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Analysis 1.6

Comparison 1 Heparin bonded catheter versus non‐heparin bonded catheters, Outcome 6 Catheter‐related infection.

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Analysis 1.7

Comparison 1 Heparin bonded catheter versus non‐heparin bonded catheters, Outcome 7 Colonization of catheter with microbes.

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Analysis 1.8

Comparison 1 Heparin bonded catheter versus non‐heparin bonded catheters, Outcome 8 Thrombocytopenia after catheter insertion.

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Comparison 1. Heparin bonded catheter versus non‐heparin bonded catheters

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Catheter‐related thrombosis at any time during catheter stay Show forest plot	2	287	Risk Ratio (M‐H, Fixed, 95% CI)	0.71 [0.44, 1.15]

2 Catheter‐related thrombosis within one week of catheter insertion Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected

3 Catheter‐related thrombosis after one week of insertion Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected

4 Occlusion of catheter within one week of catheter insertion Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected

5 Occlusion of catheter after one week of catheter insertion Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected

6 Catheter‐related infection Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected

7 Colonization of catheter with microbes Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected

8 Thrombocytopenia after catheter insertion Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected

Comparison 1. Heparin bonded catheter versus non‐heparin bonded catheters

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Referencias

References to studies included in this review

Anton 2005 {published data only}

Pierce 2000 {published and unpublished data}

References to studies excluded from this review

Appelgren 1996 {published data only}

Bennegard 1982 {published data only}

Carrasco 2004 {published data only}

Hoar 1981 {published data only}

Krafte‐Jacobs 1995 {published data only}

Mangano 1982 {published data only}

Additional references

Abdelkefi 2004

Andrew 1994

Bailey 1979

Beck 1998

Brismar 1982

de Neef 2002

Di Costanzo 1984

Gilbert 2003

Hofbauer 2000

Jacobs 2001

Klerk 2003

Marin 2000

Massicotte 1998

Mollenholt 1987

Nichols 1984

Rabe 2002

Randolph 1998

Schmugge 2002

Timsit 1998

Warkentin 1990

Characteristics of studies

Characteristics of included studies [ordered by study ID]

Characteristics of excluded studies [ordered by study ID]

Data and analyses

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