Evaluating the Impact of Central Venous Catheter Materials and Design on Thrombosis: A Systematic Review and Meta-Analysis.

BACKGROUND: 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. AIM: To systematically evaluate the effectiveness and safety of antithrombogenic materials and alterations to CVC design on thrombosis rates. METHODS: 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. RESULTS: 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. LINKING EVIDENCE TO ACTION: 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.