Manutenção da patência do cateter venoso central totalmente implantado em pacientes oncológicos: revisão sistemática

Abstract

Introduction: Fully implanted central venous catheters are fundamental in the treatment of cancer patients, providing greater safety to care and higher quality of life. Thus, the occlusion of this device is considered an event of great concern for health professionals involved in the care of this patient because it is most often linked to the suspension of therapy, exposure of the patient to a new procedure, generating delay in its treatment and high hospital cost. Objective: To evaluate the effectiveness of saline solution, compared to heparin solution in maintaining the patency of the central venous catheter fully implanted in cancer patients. Method: A systematic review was conducted based on the recommendations of the Cochrane Collaboration, using the following inclusion criteria: studies conducted with cancer patients, regardless of gender, using the fully implanted central venous catheter, in which the authors investigated the comparison of maintenance of device patency with saline and heparin. The review had the protocol registered in the International Prospective Register of Systematic Reviews-PROSPERO/NHS, under number 205074. Specific search strategies were used for the following databases: PubMed, CINAHL, Cochrane CENTRAL, LILACS, Scopus, Web of Science and EMBASE, including studies published in Portuguese, English or Spanish, without date restrictions. As a primary outcome, cvcti occlusion rates were investigated with the maintenance of patency performed with saline and heparin solution. To assess the risk of bias in the included randomized clinical trials, the tool called Revised Cochrane risk-of-bias tool for randomized trials (RoB 2) was adopted. For the assessment of the risk of bias in observational studies, the tool entitled Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) was used. The evaluation of the certainty of evidence was performed through the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Results: During the database search process, 1,008 publications were identified, with only five primary studies included in the sample (three observational studies and two randomized clinical trials). According to the results of the selected studies, no lower efficacy of saline solution was evidenced in relation to heparin solution in the prevention of CVCTI occlusion during the maintenance process of its patency, either in adult or pediatric patients. The quality of evidence certainty was very low for cohort studies, due to the heterogeneity found between the studies and the risk of identified bias and high for clinical trials. Conclusion: The results of the primary studies included in the review showed no statistically significant difference in cvci occlusion rates in the maintenance of patency in the comparison of saline solution with heparin solution, regardless of the interval performed or maintenance dose. In view of the above, it is recommended to conduct research whose design may generate strong evidence, with a view to strengthening care in the maintenance of the patency of the fully implanted central venous catheter.