Authors' objectives: This report aims to identify and summarise evidence that addresses the following research question: What is the clinical and cost effectiveness of non-antibiotic, antimicrobial and anticoagulant catheter locking solutions in the prevention of catheter-related complications?

Authors' results and conclusions: Overall, seven randomised controlled trials (RCTs) and seven non-RCT studies were identified. Across the evidence base, the comparators and population varied. Population groups included adult cancer and critical care units e.g., haematology and oncology units, adult haemodialysis patients, adult home parenteral nutrition, paediatric parenteral nutrition, paediatric chemotherapy, and paediatric intestinal failure. The evidence included in this review suggests there are some statistically significant outcomes to support the effectiveness of KiteLock, TauroLock and TauroLock-U25.000, although a large proportion of the outcomes were not reported as statistically significant and a large proportion of the evidence reporting on KiteLock were from non-RCT evidence. Most outcomes reported a lower rate of catheter/central line associated bloodstream infections in the intervention group when compared to the respective control group or pre-intervention group. For catheter patency, occlusion and thrombosis, outcomes were broadly mixed with varying statistical significance. Generally, the number of repairs or replacements needed were lower in the TauroLock and TauroLock-U25.000 groups when compared to the respective comparator groups or pre intervention groups. Both KiteLock and TauroLock-U25.000 were found to demonstrate a lower usage of recombinant tissue plasminogen activators (rt-PA) (one RCT and one non-RCT study). One RCT reported on the number of hospital admissions when using TauroLock, and found a statistically significant difference, favouring the intervention. Across the evidence base, there were no statistically significant differences in the rate of reported serious adverse events between intervention and control groups. Key uncertainties to note include that there are several retrospective cohort studies with some limitations. It is also assumed there would be a high level of heterogeneity across the evidence base due to differing populations and number of participants, different comparators, and different concentrations of solutions used for both intervention and comparison groups. Six economic analyses were identified that considered the use of KiteLock, TauroLock or TauroLock-U25.000 for people receiving haemodialysis, parenteral nutrition, haematological or oncological therapies. The studies typically estimated that additional costs of intervention were offset by lower costs of managing catheter-related complications. Consequently, the results indicated that interventions were either cost-neutral or cost-saving versus the studied comparators. However, not all relevant comparators were considered for each population. All the analyses had limitations and were only partially applicable because they considered settings outside the UK. We conducted a new cost-utility analysis to estimate the cost effectiveness of KiteLock, TauroLock and TauroLock-U25.000 in Wales, using evidence from our effectiveness review. We estimated that the higher cost of intervention was fully or partially offset by lower costs of managing infections and thrombolytic therapy. Our results indicated that TauroLock may be less costly and more effective than the modelled comparators for children receiving home parenteral nutrition, chemotherapy, or stem cell transplant and for adults receiving home parenteral nutrition or haemodialysis. KiteLock was also estimated to be less costly and at least as effective as select comparators for children receiving home parenteral nutrition and for adults receiving home parenteral nutrition or haemodialysis. KiteLock was not cost effective against heparin in haemodialysis; nor was TauroLock-U25.000 cost effective against TauroLock-HEP500. The cost effectiveness of KiteLock was most sensitive to the choice of modelled inputs and assumptions. The cost effectiveness of intervention remains unclear for comparisons not considered in the effectiveness evidence.

Authors' recommendations: The evidence partially supports the use of non-antibiotic, antimicrobial, anticoagulant catheter locking solutions for the prevention of catheter-related complications. TauroLock should be considered for children receiving home parenteral nutrition, chemotherapy or stem cell transplantation and for adults receiving home parenteral nutrition or dialysis. TauroLock is associated with fewer catheter-related bloodstream infections compared with either saline or heparin in these populations. Economic modelling suggests that TauroLock is cost effective in these comparisons and populations. The evidence does not support the case for routine adoption of TauroLock-U25.000. There is greater uncertainty in the evidence for KiteLock 4%, and, while it shows promise, the current evidence is insufficient to support routine adoption.

Authors' methods: The Evidence Appraisal Report is based on a literature search (strategy available on request) for published clinical and economic evidence on the health technology of interest. It is not a full systematic review but aims to identify the best available evidence on the health technology of interest. Researchers critically evaluate and synthesise this evidence. We include the following clinical evidence in order of priority: systematic reviews; randomised trials; non-randomised trials. We only include evidence for “lower priority” evidence where outcomes are not reported by a “higher priority” source. We also search for economic evaluations or original research that can form the basis of an assessment of costs/cost comparison. We carry out various levels of economic evaluation, according to the evidence that is available to inform this.

Authors' identified further research: The Appraisal Panel discussed gaps in the current effectiveness and cost effectiveness evidence and agreed that further research would be valuable. They noted that no evidence was identified comparing KiteLock 4% against TauroLock or TauroLock-U25.000, or on the long-term effectiveness of interventions. The Panel suggested that further comparisons against saline would be useful, given its use within standard care and clinical guideline recommendations. HTW recommends that data are collected on clinical outcomes and local experience when devices are used. The Appraisal Panel agreed that further development of the evidence base would be welcomed and may address some of the uncertainties identified in this review.

Project Status: Completed

Year Published: 2024

URL for published report: https://healthtechnology.wales/reports-guidance/catheter-locking-solutions/

English language abstract: An English language summary is available

Publication Type: Rapid Review

Country: Wales, United Kingdom

Organisation Name: Health Technology Wales

Contact Address: c/o Digital Health Care Wales, 21 Cowbridge Road East Cardiff CF11 9AD

Contact Name: Susan Myles, PhD

Contact Email: healthtechnology@wales.nhs.uk