Title : Efficacy of 18 locks solution in preventing catheter-related complication for central venous catheter device: A network meta-analysis
Purpose: The aim of this systematic review was to carry out a network meta-analysis comparing the efficacy of different locks solution for prevention of catheter-related complications in patients undergoing hemodialysis.
Methods: Seven electronic databases were searched for randomized clinical trials (RCTs) with catheter locking fluids. Two researchers independently screened the literature, extracted the main information and outcome indicators in the literature. The results were sorted by using Stata (V.14.0) and RevMan (V.5.3) software for network meta-analysis.
Results: 19 studies were included in our network meta-analysis, and 18 locks involving 5668 patients were included in this study. The results indicated that cefotaxime + heparin was more effective than that of citrate, ethanol, saline, low concentration of heparin, minocycline + EDTA + ethanol, heparin and trisodium + citrate in terms of reducing catheter-related infection (CRI). There was none of the intervention found to be statistically significantly different in preventing exit infection when compared with each other. Cefotaxime + heparin reduced bacterial colonization in catheters compared with Gentamicin+ sodium + citrate, cefazolin + gentamicin + heparin, saline, taurolidine + citrate, minocycline + EDTA+ ethanol, heparin and citrate. Cotrimoxazole + heparin prevented the occur of thrombosis compared with ethanol and csathasept. Recombinant tissue plasminogen activator (Rt-PA) can reduce adverse reaction compared with csathasept. Rt-PA, heparin, citrate, (sodium citrate + methylene blue + methylparaben + propylparaben) C-MB-P and csathasept were more effective than that of ethanol + sodium + citrate in term of reducing the happen of adverse reaction.
Conclusion: Our findings indicated that the cefotaxime + heparin may be the best way to prevent CRI, catheter remove and colonized bacteria. Cotrimoxazole + heparin might lead to the lowest incidence of existence of infection and thrombotic occurrence. RT-PA might have the lowest risk of adverse reaction. Because the evidence of reticular meta-analysis is relatively insufficient, special attention should be paid to these catheter locking solutions in clinical application.