Intravenous literature: Mitchell, M.D., Agarwal, R., Hecht, T.E. and Umscheid, C.A. (2012) Nonpharmacologic interventions for prevention of catheter-related thrombosis: A systematic review. Journal of Critical Care. Sep 13. [Epub ahead of print].
PURPOSE: The aim of this study was to summarize randomized controlled trials (RCTs) of nonpharmacologic interventions for prevention of catheter-related thromboses (CRTs).
METHODS: MEDLINE, EMBASE, CINAHL, and Cochrane Central Register of Controlled Trials were systematically searched for RCTs examining any nonpharmacologic intervention to prevent symptomatic or asymptomatic CRT. Titles and abstracts were screened by a single reviewer, followed by full-text screening by 2 independent reviewers. Data were extracted and quality assessed by a single analyst and audited by a second analyst. Strength of the evidence for each intervention was assessed using the Grading of Recommendations Assessment, Development and Evaluation.
RESULTS: Ten RCTs enrolling 1,378 patients were included. Moderate- to high-quality evidence suggested peripherally inserted central catheters and insertion of central venous catheters (CVCs) at the femoral site increased CRT when compared with other catheter types or insertion sites, respectively. Evidence comparing CRT in CVCs inserted at the jugular vs the subclavian site as well as the placement of the CVC tip was of low quality and inconclusive. Low-quality evidence suggested that valved ports and silver-coated catheters had no effect on CRT. No RCT evidence was identified for other interventions.
CONCLUSIONS: Peripherally inserted central catheters and femoral insertion of CVCs should be avoided if possible. Randomized controlled trials are needed to ascertain the effects of other nonpharmacologic interventions to prevent CRT.