Central venous catheters are used for prolonged intravenous therapy in the management of critically ill children, for parenteral nutrition, medication and monitoring. Having these catheters in place can cause blood clots in or around the end of the catheter as well as infection, either local or a blood stream infection. As a result, the catheter becomes blocked, eventually to the point that it is occluded and can no longer be used to give fluids. Anticoagulant drugs such as heparin can be given to prolong the usefulness of the catheter or the catheters coated with heparin (heparin-bonded catheters). Heparin can cause side effects such as bleeding, allergic reactions, induced thrombocytopenia (an abnormal drop in the number of platelets in the blood) and osteoporosis with long-term use.
The review authors identified two good quality controlled trial that randomized 287 children aged one day to 16 years to either a heparin-bonded catheter or a standard catheter. The median duration of time that the catheter could be used to give fluids (its patency) was not clearly different with the two types of catheter, seven days in the heparin-bonded catheter group and six days in the standard catheter group. There was a trend towards the heparin-bonded catheter reducing the risk of catheter-related thrombosis over the time the catheter was in and a trend towards reduction in the risk of catheter occlusion in the first week after catheter placement.
The risk of catheter-related infections and bacterial colonization of the catheter were significantly reduced using the heparin-bonded catheter, with a longer time to develop infection (delayed in the heparin-bonded catheter group). There was no significant difference in risk of thrombocytopenia after catheter placement.