Study designs of evaluations included in the review
Randomised controlled trials (RCTs) of central venous and pulmonary artery catheter-related complications were included if the individual adult or paediatric patients were randomised. Studies with greater than 40% of patients excluded from analysis post-randomisation were excluded. Three retrieved trials were excluded for the following reasons: a drop-out rate of greater than 50%; a heparin drip was used in both treatment arms; and the primary data were not extractable.
Specific interventions included in the review
Prophylactic heparin delivered in the following ways:
infusion through central venous and pulmonary artery catheters in doses ranging from 50 to 5,000 units every 12 hours;
added to total parenteral nutrition in doses ranging from 1 to 3 units/mL;
subcutaneous administration in doses of 2,500 units, four times per day; and
bonded to the catheter.
Participants included in the review
Adults or paediatric patients whose treatment included the insertion of central venous catheters and pulmonary artery catheters. The studies included children and adults receiving oncology treatment, and adults with medical, surgical (including coronary artery bypass graft) and gastroenterological illness.
Outcomes assessed in the review
The following outcomes were assessed: catheter thrombus or fibrin sheath formation; catheter-related deep vein thrombosis; catheter colonisation; and catheter-related bacteraemia and sepsis. The following a priori definitions were formulated:
duration of catheter patency, defined as the number of hours the catheters were in place;
catheter thrombosis, defined as clot adhering to or occluding the catheter or a fibrin sleeve in the vessel around the catheter;
catheter-related vessel thrombosis, defined as partial or total occlusion of blood flow through the vessel;
catheter colonisation, defined as at least 15 cfu cultured from catheter tip using the semi-quantitative method of Maki et al. (see Other Publications of Related Interest no.1).
How were decisions on the relevance of primary studies made?
The authors do not state how the papers were selected for the review, or how many of the authors performed the selection.