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Cover of Central Venous Access Devices (CVADs) and Peripherally Inserted Central Catheters (PICCs) for Adult and Pediatric Patients: A Review of Clinical Effectiveness and Safety

Central Venous Access Devices (CVADs) and Peripherally Inserted Central Catheters (PICCs) for Adult and Pediatric Patients: A Review of Clinical Effectiveness and Safety

Rapid Response Report: Summary with Critical Appraisal

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Central venous access devices (CVADs) or central venous catheters (CVCs) are devices that are inserted into the body through a vein to enable the administration of fluids, blood products, medication and other therapies to the bloodstream. CVADs can be inserted into the subclavian or jugular vein (implanted ports, tunneled catheters), or can be inserted into one of the peripheral veins of the upper extremities, called peripherally inserted central catheters (PICCs).1

While generally safe, CVADs can be associated with complications such as catheter occlusion or rupture, venous thrombosis, and bloodstream infection.1 A number of strategies have been used to minimize the occurrence of CVAD- and PICC-associated complications such as antimicrobial-impregnated lines for prevention of infection, or addition of a valve (valved catheters) to prevent occlusion by preventing reflux of blood into the catheter.2 Flushing the catheters with saline or heparin – an agent with anticoagulant activity - have been used to reduce clot formation and occlusion of the catheters.

This Rapid Response report is an update of the previous CADTH reports which found no difference in terms of frequency of occlusion in patients who had a valved versus a non-valved PICCs, and similar patency between heparin and saline use for CVCs.3,4 This report aims to review the evidence on the clinical effectiveness of valved versus non-valved PICCs, and saline versus heparin flushing in the maintenance of CVADs patency and reduction of complications.

About the Series

Rapid Response Report: Summary with Critical Appraisal
ISSN: 1922-8147

The information in this document is intended to help Canadian health care decision-makers, health care professionals, health systems leaders, and policy-makers make well-informed decisions and thereby improve the quality of health care services. While patients and others may access this document, the document is made available for informational purposes only and no representations or warranties are made with respect to its fitness for any particular purpose. The information in this document should not be used as a substitute for professional medical advice or as a substitute for the application of clinical judgment in respect of the care of a particular patient or other professional judgment in any decision-making process. The Canadian Agency for Drugs and Technologies in Health (CADTH) does not endorse any information, drugs, therapies, treatments, products, processes, or services.

While care has been taken to ensure that the information prepared by CADTH in this document is accurate, complete, and up-to-date as at the applicable date the material was first published by CADTH, CADTH does not make any guarantees to that effect. CADTH does not guarantee and is not responsible for the quality, currency, propriety, accuracy, or reasonableness of any statements, information, or conclusions contained in any third-party materials used in preparing this document. The views and opinions of third parties published in this document do not necessarily state or reflect those of CADTH.

CADTH is not responsible for any errors, omissions, injury, loss, or damage arising from or relating to the use (or misuse) of any information, statements, or conclusions contained in or implied by the contents of this document or any of the source materials.

This document may contain links to third-party websites. CADTH does not have control over the content of such sites. Use of third-party sites is governed by the third-party website owners’ own terms and conditions set out for such sites. CADTH does not make any guarantee with respect to any information contained on such third-party sites and CADTH is not responsible for any injury, loss, or damage suffered as a result of using such third-party sites. CADTH has no responsibility for the collection, use, and disclosure of personal information by third-party sites.

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Copyright © 2017 Canadian Agency for Drugs and Technologies in Health.

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Except where otherwise noted, this work is distributed under the terms of a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International licence (CC BY-NC-ND), a copy of which is available at http://creativecommons.org/licenses/by-nc-nd/4.0/

Bookshelf ID: NBK470804PMID: 29293304

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