Citrate as a safe and effective alternative to heparin for catheter locking: a systematic review and meta-analysis of randomized controlled trials.

Abstract

Background: Consensus on the use of citrate vs.heparin for catheter locking remains elusive, with ongoing controversy. This meta-analysis investigates the efficacy and safety of citrate lock solutions compared to heparin lock solutions in preventing catheter-related complications.

Methods: The review process was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Two independent reviewers conducted literature searches based on preferred reporting items from systematic reviews and meta-analyses. PubMed, EMBASE, Medline, and the Cochrane Library were searched for studies comparing citrate and heparin in patients with catheter. Catheter-related bloodstream infection (CRBSI), catheter-related infection (CRI), exit-site infection (ESI), and adverse events were analyzed.

Results: The meta-analysis included 17 randomized controlled trials (RCTs), encompassing 247,431 catheter-days, with 128,904 in the citrate group, and 118,527 in the heparin group. Citrate lock solutions significantly reduced the incidence of CRBSI compared to heparin (RR: 0.48, 95% CI: 0.31-0.73), particularly when combined with antibiotics or used at low concentrations. No significant differences were observed between the groups for CRI, ESI, catheter dysfunction, or local bleeding. Subgroup and sensitivity analyses addressed heterogeneity, confirming the robustness of the primary findings.

Conclusions: Citrate lock solutions effectively prevent CRBSI without increasing systemic coagulation dysfunction or bleeding risk. Citrate lock solutions are a safe and effective alternative to heparin, especially when combined with antibiotics.

Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024562511.