Comparison of the Effects of Heparin and 0.9% Sodium Chloride Solutions in Maintenance of Patency of Central Venous Catheters

Abstract

BackgroundOcclusion of central venous catheters is one of the limiting factors in using them. Heparinized saline solution is the standard solution used for keeping the catheters open.ObjectivesThis study aimed to determine the effect of heparin saline solution and normal saline in maintenance of patency of central venous catheters.Patients and MethodsThis double-blind study was performed on 84 patients of intensive care unit who had central venous catheters. The patients were randomly divided into two groups of heparin saline receivers and normal saline receivers. In the heparin group after each drug injection into the lumen, 3 mL of heparin saline solution was injected in the catheter as well. The other group only received 10 mL of normal saline instead. The catheters were examined for blood return and flushing every eight hours for 21 days. Data was analyzed using SPSS software version 20 and descriptive and analytic statistics were studied.ResultsThere was no significant difference in the rate of flushing (P = 0.872) and possibility of taking blood samples from catheters (P = 0.745) in the two groups of heparin and normal saline receivers. Furthermore, using heparin had no effect on prolonging the survival of catheters.ConclusionsConsidering possible side effects of heparin and the increase in treatment charges and the fact that using heparin did not have a significant effect on patency and survival of catheters in the studied patients, it is recommended to use normal saline solution to maintain the patency of central venous catheters.

Effectiveness of heparin versus 0.9% saline solution in maintaining the permeability of central venous catheters: a systematic review

“…In short, we should mention that the consensus among various authors and our results are consistent, allowing us to draw the following conclusions: the saline solution is sufficient for maintaining patency of CVC when compared to heparinized solutions (2,(9)(10)(11)(12)(13)(14)16) ; saline solution prevents exposure to complications arising from the use of heparin -these being thrombocytopenia, bleeding (11,12,14,16) … thereby adding significance when associated with differences in the dilutions used (often by the team itself ), non-uniformity of pre-established protocols and potential errors of medication preparation (1) .…”

“…Bibliography analysis of identified reference articles also allowed the inclusion of another study, thus nine studies were considered for critical appraisal: eight RCT (2,6,9,(11)(12)(13)(14)16) and one cohort study (10) .…”

“…In this context, some published studies have reported that most nurses use only saline solutions, enhancing the fact that CVC flushing practices vary widely, and are currently inconsistent (15) . This fact is even more significant because most existing guidelines for maintaining CVC are not based on evidence and do not identify any recommendations that promote flushing with only saline solution (16) . When considering these gaps, this issue was identified as a research priority that could indicate significant benefits for the reduction of adverse events (5) .…”

Venous access devices: Clinical rounds

“…Data suggest no difference in the rate of occlusion when using heparin versus normal saline flush maintenance procedures,[37] yet others report higher incidence of complications when using saline flush only. [38] The use of tissue plasminogen activator (t-PA) as a lock or infusion maintenance to prevent occlusions cannot be supported by evidence.…”

“…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.…”