Abstract
Objective: to evaluate the effectiveness and safety in the use of second-generation central venous catheters impregnated in clorhexidine and silver sulfadiazine when compared with other catheters, being them impregnated or not, in order to prevent the bloodstream infection prevention.Method: systematic review with meta-analysis. Databases searched: MEDLINE, EMBASE, CINAHL, LILACS/SciELO, Cochrane CENTRAL; search in Congress Proceedings and records from Clinical Trials.Results: 1.235 studies were identified, 97 were pre-selected and 4 were included. In catheter-related bloodstream infection, there was no statistical significance between second-generation impregnated catheter compared with the non-impregnated ones, absolute relative risk 1,5% confidence interval 95% (3%-1%), relative risk 0,68 (confidence interval 95%, 0,40-1,15) and number needed to treat 66. In the sensitivity analysis, there was less bloodstream infection in impregnated catheters (relative risk 0,50, confidence interval 95%, 0,26-0,96). Lower colonization, absolute relative risk 9,6% (confidence interval 95%, 10% to 4%), relative risk 0,51 (confidence interval 95% from 0,38-0,85) and number needed to treat 5.Conclusion: the use of second-generation catheters was effective in reducing the catheter colonization and infection when a sensitivity analysis is performed. Future clinical trials are suggested to evaluate sepsis rates, mortality and adverse effects.
Highlights
The Central Venous Catheters (CVC) are indispensable for the treatment of critical patients both with acute and chronic illnesses
All the interventions evaluated secondwww.eerp.usp.br/rlae generation CVC impregnated in clorhexidine and silver sulfadiazine, compared with non-impregnated CVC; they evaluated the primary outcome Catheter-Related Bloodstream Infection (CRBSI) and secondary: colonization, sepsis and local infection
During the selection of the studies for this research, we found studies directed to children just with firstgeneration CVC’s impregnated with clorhexidine and silver sulfadiazine but these studies did not report the findings for children and adults separately
Summary
The Central Venous Catheters (CVC) are indispensable for the treatment of critical patients both with acute and chronic illnesses. Several procedures are performed in order to prevent the CRBSI’s such as the use of a maximal sterile barrier (cap, mask, sterile gown, gloves and sterile drapes), reduction in the time for catheter insertion, cutaneous antisepsis with clorhexidine 2% in the CVC insertion site, educational programs for the health teams, and avoiding femoral vein for the insertion(5). It has been proposed the impregnation, coating or linkage with antimicrobials to prevent the CRBSI’s(5-6)
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