BACKGROUND Central venous catheters are used extensively as temporary or permanent vascular access for haemodialysis patients. Catheter-related bloodstream infections are the main complication of central venous catheters and increase morbidity and mortality in haemodialysis patients. OBJECTIVES The aim was to assess the most appropriate lock solution for central venous catheters to prevent catheter-related bloodstream infections and other complications. DATA SOURCES Medline, Embase and the Cochrane Central Register of Controlled Trials from the date of their inception to August 2018 were used as data sources. The reference lists of eligible studies and relevant reviews were also checked. STUDY ELIGIBILITY CRITERIA AND PARTICIPANTS Randomized controlled trials (RCTs) comparing different lock solutions for the prevention of central venous catheter-related infectious and bleeding complications for adult dialysis patients were included. INTERVENTIONS Interventions were lock solutions for haemodialysis catheters. METHODS The primary outcomes were catheter-related bloodstream infections and bleeding events. The secondary outcomes were catheter malfunction, exit-site infection, and all-cause mortality. We estimated summary risk ratios (RRs) using pairwise and network meta-analysis. We assessed the risk of bias of individual studies with the Cochrane risk of bias tool. RESULTS Forty-nine trials (7020 patients) were included for this study. Compared with heparin 5000 U/mL, antibiotic locks (antibiotics with trisodium citrate (TSC), ethylenediamine tetraacetic acid (EDTA), heparin 5000 U/mL, low-dose heparin or urokinase) and ethanol locks were more effective in preventing catheter-related bloodstream infections. Antimicrobial agents plus low-dose heparin (500-2500 U/mL), TSC and low-dose heparin locks had lower risk of bleeding events than heparin 5000 U/mL. None of the lock solutions reduced rates of catheter malfunction and all-cause mortality compared with heparin 5000 U/mL. In summary, antibiotics plus low-dose heparin was ranked as the best lock solution. The overall results were not materially changed in sensitivity analyses. CONCLUSIONS Taking into account both efficacy and safety, antibiotics plus low-dose heparin (500-2500 U/mL) may be the preferred lock solution.

中文翻译：

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锁定解决方案预防成人血液透析患者导管相关并发症（包括感染和出血事件）的比较疗效和安全性：系统评价和网络荟萃分析。

背景技术中心静脉导管广泛用作血液透析患者的临时或永久血管通路。导管相关血流感染是中心静脉导管的主要并发症，会增加血液透析患者的发病率和死亡率。目的 目的是评估最合适的中心静脉导管封堵解决方案，以预防导管相关的血流感染和其他并发症。数据来源 Medline、Embase 和 Cochrane Central Register of Controlled Trials 从成立之日到 2018 年 8 月被用作数据来源。还检查了符合条件的研究和相关评论的参考列表。研究资格标准和参与者 随机对照试验 (RCT) 比较了不同的锁定解决方案，以预防成人透析患者的中心静脉导管相关感染和出血并发症。干预措施 干预措施是血液透析导管的锁定溶液。方法 主要结局是导管相关的血流感染和出血事件。次要结局是导管故障、出口部位感染和全因死亡率。我们使用成对和网络荟萃分析估计了汇总风险比 (RR)。我们使用 Cochrane 偏倚风险工具评估了个别研究的偏倚风险。结果 本研究纳入了 49 项试验（7020 名患者）。与肝素 5000 U/mL 相比，抗生素锁（含柠檬酸三钠 (TSC) 的抗生素，乙二胺四乙酸 (EDTA)、肝素 5000 U/mL、低剂量肝素或尿激酶）和乙醇锁在预防导管相关血流感染方面更有效。与肝素 5000 U/mL 相比，抗菌药物加低剂量肝素 (500-2500 U/mL)、TSC 和低剂量肝素锁的出血事件风险更低。与肝素 5000 U/mL 相比，没有一种锁定溶液可降低导管故障率和全因死亡率。综上所述，抗生素加低剂量肝素被列为最佳锁定方案。敏感性分析中的总体结果没有实质性变化。结论 考虑到疗效和安全性，抗生素加低剂量肝素（500-2500 U/mL）可能是首选的锁定方案。低剂量肝素或尿激酶）和乙醇锁在预防与导管相关的血流感染方面更有效。与肝素 5000 U/mL 相比，抗菌药物加低剂量肝素 (500-2500 U/mL)、TSC 和低剂量肝素锁的出血事件风险更低。与肝素 5000 U/mL 相比，没有一种锁定溶液可降低导管故障率和全因死亡率。综上所述，抗生素加低剂量肝素被列为最佳锁定方案。敏感性分析中的总体结果没有实质性变化。结论 考虑到疗效和安全性，抗生素加低剂量肝素（500-2500 U/mL）可能是首选的锁定方案。低剂量肝素或尿激酶）和乙醇锁在预防与导管相关的血流感染方面更有效。与肝素 5000 U/mL 相比，抗菌药物加低剂量肝素 (500-2500 U/mL)、TSC 和低剂量肝素锁的出血事件风险更低。与肝素 5000 U/mL 相比，没有一种锁定溶液可降低导管故障率和全因死亡率。综上所述，抗生素加低剂量肝素被列为最佳锁定方案。敏感性分析中的总体结果没有实质性变化。结论 考虑到疗效和安全性，抗生素加低剂量肝素（500-2500 U/mL）可能是首选的锁定方案。TSC 和低剂量肝素锁的出血事件风险低于肝素 5000 U/mL。与肝素 5000 U/mL 相比，没有一种锁定溶液可降低导管故障率和全因死亡率。综上所述，抗生素加低剂量肝素被列为最佳锁定方案。敏感性分析中的总体结果没有实质性变化。结论 考虑到疗效和安全性，抗生素加低剂量肝素（500-2500 U/mL）可能是首选的锁定方案。TSC 和低剂量肝素锁的出血事件风险低于肝素 5000 U/mL。与肝素 5000 U/mL 相比，没有一种锁定溶液可降低导管故障率和全因死亡率。综上所述，抗生素加低剂量肝素被列为最佳锁定方案。敏感性分析中的总体结果没有实质性变化。结论 考虑到疗效和安全性，抗生素加低剂量肝素（500-2500 U/mL）可能是首选的锁定方案。