A Randomized Controlled Comparison of Flushing Protocols in Home Care Patients With Peripherally Inserted Central Catheters

Lyons, Margaret; Phalen, Ann Gibbons

doi:10.1097/nan.0000000000000050

Cited by 22 publications

(19 citation statements)

References 26 publications

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“…Thus, a total of 10 studies were eligible according to the inclusion criteria. The 10 studies were from Germany [13] ( n = 1), Spain [6] ( n = 1), Belgium [26] ( n = 1), Italy [27] ( n = 1), Japan [28] ( n = 1), Iran [29, 30] ( n = 2) and the USA [2, 31, 32] ( n = 3). As a result, the 10 trials, including four ICU and six non-ICU studies, were reported in the years 2002–2015 and the average duration of follow up ranged from 1 to 400 days.…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Normal saline versus heparin for patency of central venous catheters in adult patients - a systematic review and meta-analysis

Zhong

Wang²,

et al. 2017

Crit Care

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BackgroundHeparin saline (HS) is theoretically superior to normal saline (NS) for maintaining the patency of central venous catheters (CVCs), but the comparative efficacy of them remains controversial. The aim of this systematic review and meta-analysis was to assess the efficacy of NS versus HS in the maintenance of the patency of CVCs in adult patients.MethodsWe searched PubMed, Embase and the Cochrane library databases. Randomized controlled trials (RCTs) evaluating the use of NS vs. HS to maintain the permeability of CVCs among adult patients were included in our meta-analysis. References of relevant papers were reviewed manually. No language restriction was applied. Non-human studies were excluded. Pooled relative risk (RR) was calculated using a Mantel-Haenszel random-effects model. We also performed subgroup analysis examining the effect of the duration of catheter placement on the outcome. All statistical tests were two-sided using a significance level of 0.05.ResultsTen RCTs involving 7875 subjects (with analysis at patient, catheter, lumen and line access level) were included in this meta-analysis. Whether in terms of pooled or local analysis (RR with 95% confidence interval spans 1), NS can be equally, if not more effective, in keeping the CVCs open. Of studies reporting secondary outcomes (maneuver needed, heparin-induced thrombocytopenia, haemorrhage, central venous thrombosis and catheter-related bloodstream infection), heparinised saline was shown not to be superior to non-heparinised solution. Subgroup analysis in patients with short vs long term CVC placement was consistent with the main outcome partly and in particular for maintenance of catheter patency in patients with a long-term placement i.e. >30 days, the RR was 0.97 (n = 6589; 95% CI = 0.76 to 1.23; P = 0.796). However, for patients in whom the catheter was in place for <30 days, the RR was 1.52 (n = 1286; 95% CI = 1.02 to 2.27; P = 0.041).ConclusionsBased on the results of this meta-analysis, HS is not superior to NS in reducing CVCs occlusion. But in the short term, the use of HS is slightly superior to NS for flushing catheters from a statistical point of view.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-016-1585-x) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

“…In the Lyons trial [31], a comparison of 0.9% NaCl with two different concentrations of heparin (10 and 100U/ml) was presented. Consequently, we divided the data into two sets and performed statistical analysis.…”

Section: Resultsmentioning

confidence: 99%

Normal saline versus heparin for patency of central venous catheters in adult patients - a systematic review and meta-analysis

Zhong

Wang²,

et al. 2017

Crit Care

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“…Proper flushing techniques are effective, inexpensive and associated with good clinical practice (Ferroni et al 2014). National and international guidelines include flushing recommendations in C. Cullinane (*) Health and Social Care (1st Class), Liverpool, UK e-mail: caroline.cullinane@rlbuht.nhs.uk concurrence with manufacturer instructions for use (IFUs) to optimise VAD safety, function and durability, for all patients requiring short-to long-term IV therapy (RCN 2016;Gorski et al 2016;Lyons 2012;Loveday et al 2014).…”

Section: Flushing Rationalementioning

confidence: 99%

“…To maximise catheter lumen patency, neither technique nor technology can stand alone (Hadaway 2006b). Guidelines also always suggest adherence to local policy and manufacturer's instructions for use (RCN 2016;Lyons 2012;EPIC 3 2014;ESPEN 2009;Gorski et al 2016). Short peripheral catheters, extended dwell catheters, midlines and PICCs may be particularly affected by blood reflux due to small lumen size and greater surface area.…”

Section: Other Factors Affecting Blood Refluxmentioning

confidence: 99%

Right Management and Flushing

Cullinane¹

2019

Vessel Health and Preservation: The Right Approach for Vascular Access

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Peripheral and central vascular access devices are a fundamental and essential part of healthcare delivery, used extensively in hospital and community settings to meet the challenging and complex IV therapy requirements of the modern-day patient. For vascular access devices (VAD) to be a safe and effective tool for the administration of IV therapy, they must be reliable. Reliability in this context refers to optimal catheter function, demonstrated by the ease of flushing and aspirating, combined with an absence of associated complications. Proficient care and maintenance of these devices by healthcare professionals requires a high degree of knowledge, skill and understanding. In this section, we explore the details of flushing by examining how, why, when and with what solution vascular devices are to be flushed.

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“…Due to inconsistent variables and low numbers of study participants, comparisons of efficacy between heparin solutions of various concentrations versus saline-only flushes are inconclusive. [3738535455] Based on the available data, evidence-based standard of care consists of flushing all VADs with 0.9% normal saline after blood sampling and following medication administration; pulsatile flushing techniques are recommended. No definitive recommendation can be made regarding heparin solutions versus saline solution use, the most effect flush volume, or frequency.…”

Section: Occlusionmentioning

confidence: 99%

Venous access devices: Clinical rounds

Matey

Camp-Sorrell

2016

Asia-Pacific Journal of Oncology Nursing

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Nursing management of venous access devices (VADs) requires knowledge of current evidence, as well as knowledge of when evidence is limited. Do you know which practices we do based on evidence and those that we do based on institutional history or preference? This article will present complex VAD infection and occlusion complications and some of the controversies associated with them. Important strategies for identifying these complications, troubleshooting, and evaluating the evidence related to lack of blood return, malposition, infection, access and maintenance protocols, and scope of practice issues are presented.

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A Randomized Controlled Comparison of Flushing Protocols in Home Care Patients With Peripherally Inserted Central Catheters

Cited by 22 publications

References 26 publications

Normal saline versus heparin for patency of central venous catheters in adult patients - a systematic review and meta-analysis

Normal saline versus heparin for patency of central venous catheters in adult patients - a systematic review and meta-analysis

Right Management and Flushing

Venous access devices: Clinical rounds

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