Which intravenous catheter lock solution works best?

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Which catheter lock solution (CLS) works best and safe for patients with catheter-related blood infections (CRBSI) remains questionable. Therefore, we compared the efficacy of different catheter lock solutions (CLSs) for prevention of CRBSI and rank these CLSs for practical consideration” Dang et al (2019).

Abstract:

OBJECTIVES: Which catheter lock solution (CLS) works best and safe for patients with catheter-related blood infections (CRBSI) remains questionable. Therefore, we compared the efficacy of different catheter lock solutions (CLSs) for prevention of CRBSI and rank these CLSs for practical consideration.

METHODS: We searched PubMed, Web of Science, Embase and MEDLINE, earlier relevant meta-analysis and reference lists of included. Primary outcome was CRBSI, and secondary outcomes were catheter-related thrombosis (CRT) and exit-site infections. We performed a network meta-analysis to estimate odds ratios (ORs) with 95% confidence interval (CI).

RESULTS: Finally, 52 RCTs involving 9099 patients and evaluating 13 CLSs (alone or combination) were included. The quality of the evidence was typical of low or unclear risk of bias (45 out of 52 trials, 86.5%). In network meta-analysis, saline (odds ratio (OR) 8.44, 95% CI 2.19 to 32.46), gentamicin + citrate (2.92, 1.32 to 6.42), ethanol (5.33, 1.22 to 23.32) and cloxacillin + heparin (2.07, 1.19 to 5.49) were associated with more effect on the CRBSI than heparin.

CONCLUSIONS: Our network meta-analysis showed that EDTA seemed to be the most effective for CRBSI and Exit-site infection, and cefotaxime + heparin seemed to be the most effective for CRT.

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Reference:

Dang, F.P., Li, H.J., Wang, R.J., Wu, Q., Chen, H., Ren, J.J. and Tian, J.H. (2019) Comparative efficacy of various antimicrobial lock solutions for preventing catheter-related bloodstream infections: a network meta-analysis of 9099 patients from 52 randomized controlled trials. International Journal of Infectious Diseases. August 20th. doi: 10.1016/j.ijid.2019.08.017. .

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