Comparison of the Efficacy of Continuous Saline Infusion to Prevent Catheter Occlusion: A Systematic Review and Meta-Analysis.

Abstract

Central venous catheters (CVCs) are essential in managing critically ill patients but are frequently complicated by occlusion, which can necessitate catheter replacement and increase the risk of complications such as catheter-related bloodstream infection (CRBSI). Continuous saline infusion devices have emerged as a potential intervention to maintain catheter patency, as continuous fluid administration is the common measure of fluid administration, though a persistently high occlusion rate remains in the high-risk population. This systematic review and meta-analysis assessed the efficacy of continuous saline infusion versus standard of care, including intermittent flushing and catheter lock, in preventing catheter occlusion. We searched MEDLINE, Embase, Cochrane CENTRAL, ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform (ICTRP) up to February 11th, 2025. Two randomized controlled trials (RCTs) involving 297 participants met the inclusion criteria. Both studies enrolled patients with newly placed CVCs, including critically ill populations, with an occlusion incidence of 33%. The included studies had an overall high risk of bias. Meta-analysis demonstrated a risk ratio (RR) of 0.51 (95% CI), corresponding to an absolute risk reduction of 267 occlusion events per 1,000 patients with low certainty. The incidence of CRBSI was not significantly different between groups (RR: 3.02, 95% CI: 0.12-73.52; low certainty). No catheter-related thrombosis or unexpected catheter removals were reported, with very low certainty of evidence. Adverse events were infrequent and primarily involved leakage at the catheter site. In conclusion, our findings suggest that continuous saline infusion may be considered for high-risk patients to prevent CVC occlusion. Further high-quality trials are needed to confirm these findings and evaluate their impact on clinically relevant outcomes such as thrombosis and infection.