Authors' objectives: Identify and summarize evidence on the comparative safety and effectiveness of locking solutions for central venous access devices.

Authors' results and conclusions: ▪ There have been numerous randomized controlled trials comparing various solutions for locking central venous catheters (CVC) between uses. Systematic reviews of this evidence base included a Cochrane review and two network meta-analyses that can be used to estimate the comparative effectiveness of different solutions for preventing central line-associated bloodstream infection (CLABSI), catheter occlusion, and bleeding. There was insufficient evidence on which to base any conclusions about catheter-associated thrombosis. Many of these trials were reported to have a moderate to high risk of bias. ▪ Locking solutions containing antimicrobial agents reduce CLABSI rates by 50% or more relative to heparin solution without an antimicrobial: the evidence for this conclusion is of high strength. Antimicrobial agents likely do not significantly affect catheter occlusion, and likely reduce risk of bleeding events compared to heparin. Evidence for these conclusions is of moderate strength. Evidence on the comparative safety and effectiveness of different antimicrobial solutions is inconclusive. ▪ Despite the effectiveness of antimicrobial locking solutions, they are not recommended in clinical practice guidelines because of concerns over antimicrobial stewardship and antimicrobial resistance. ▪ Locking CVCs with saline solution instead of heparin solutions increases risk of catheter occlusion but may reduce risk of bleeding. Any improvement in catheter patency with heparin solutions is likely to be of a small duration though. Evidence is of low to moderate strength for these conclusions. Use of a lower-concentration heparin (compared to normal concentration heparin) locking solution reduces bleeding risk but may increase risk of catheter occlusion; there is likely no significant effect on CLABSI rates. Low- to moderate-strength evidence for these conclusions. ▪ Current practice at all UPHS hospitals is to flush and lock CVCs with normal saline. The hospital policies are in accord with guidelines from the Infusion Nurses Society.

Project Status: Completed

Year Published: 2024

URL for published report: https://www.med.upenn.edu/CEP/external-request-form.html

English language abstract: An English language summary is available

Publication Type: Rapid Review

Country: United States

Organisation Name: Penn Medicine Center for Evidence-based Practice

Contact Address: Penn Medicine Center for Evidence-based Practice, University of Pennsylvania Health System, 3600 Civic Center Blvd, 3rd Floor West, Philadelphia PA 19104

Contact Name: Nikhil Mull

Contact Email: cep@pennmedicine.upenn.edu

Copyright: <p>Center for Evidence-based Practice (CEP)</p>