School of Nursing, Queensland University of Technology, Brisbane, Qld, Australia.
Alliance for Vascular Access Teaching and Research Group (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Qld, Australia.
Worldviews Evid Based Nurs. 2020 Oct;17(5):376-384. doi: 10.1111/wvn.12472.
Thrombosis is a common complication associated with central venous catheter (CVC) insertion. Several antithrombogenic materials and alterations to catheter design have been developed to lower thrombosis rates.
To systematically evaluate the effectiveness and safety of antithrombogenic materials and alterations to CVC design on thrombosis rates.
A systematic search was completed of main databases (CINAHL, EMBASE, MEDLINE, and PubMed) as well as trial registries and gray literature. Randomized controlled trials conducted in any age group, published in English language since 2008 reporting impact of different CVC designs or materials on thrombosis were included, to capture studies that reflect contemporary products and practice. Cochrane systematic review methodology was followed, including independent study selection and data extraction. Quality appraisal was conducted using the Cochrane risk of bias tool. A narrative synthesis and meta-analysis in RevMan were conducted.
From a possible 232 studies, nine studies met the inclusion criteria. Four studies (n = 1,320) assessed different catheter materials; four studies (n = 591) compared different CVC designs, and one study (n = 150) evaluated impact of combined design and material on outcomes. Meta-analysis demonstrated that neither catheter material nor design alone or in combination had a significant impact on thrombosis (RR: 0.98 [95% CI 0.87, 1.11]). Different catheter materials and design also had no significant impact on occlusion or CRBSI. Studies were of mixed quality overall.
Different CVC materials and designs were not associated with a reduction in the risk of either catheter-related thrombosis or infection. Overall reporting and small sample sizes make it difficult to draw firm conclusions. Larger, quality randomized trials are required to provide evidence about the possible merits of innovative catheter design and materials on patient outcomes.
血栓形成是与中心静脉导管（CVC）插入相关的常见并发症。已经开发了几种抗血栓形成材料和导管设计的改变，以降低血栓形成率。
系统评估抗血栓形成材料和 CVC 设计改变对血栓形成率的有效性和安全性。
对主要数据库（CINAHL、EMBASE、MEDLINE 和 PubMed）以及试验注册处和灰色文献进行了系统搜索。纳入了自 2008 年以来以英文发表的、任何年龄组的、报告不同 CVC 设计或材料对血栓形成影响的随机对照试验，以捕捉反映当代产品和实践的研究。采用 Cochrane 系统评价方法，包括独立的研究选择和数据提取。使用 Cochrane 偏倚风险工具进行质量评估。采用 RevMan 进行叙述性综合和荟萃分析。
从可能的 232 项研究中，有 9 项研究符合纳入标准。四项研究（n=1320）评估了不同的导管材料；四项研究（n=591）比较了不同的 CVC 设计，一项研究（n=150）评估了联合设计和材料对结果的影响。荟萃分析表明，导管材料或设计本身或联合使用均未显著影响血栓形成（RR：0.98 [95% CI 0.87, 1.11]）。不同的导管材料和设计也没有对闭塞或导管相关血流感染（CRBSI）产生显著影响。总体而言，研究质量参差不齐。
不同的 CVC 材料和设计与降低导管相关血栓形成或感染的风险无关。总体报告和小样本量使得难以得出明确的结论。需要进行更大规模、高质量的随机试验，以提供关于创新导管设计和材料对患者结局可能带来益处的证据。
