Continuous heparin infusion to prevent thrombosis and catheter occlusion in neonates with peripherally placed percutaneous central venous catheters

Effect of heparin and other factors associated with complications of peripherally inserted central venous catheters in neonates

“…These include catheter diameter (gauge), location of catheter tip, fluid infusion rate, dwell time, length of catheter outside the skin and precipitation of calcium and phosphate salts within the tubing. [4][5][6]8,15,16 Although the concentration of heparin used in the first epoch of this study (0.25 to 0.5 units ml À1 ) is low, the dose (0.5 to 2 units kg À1 per h) is comparable to recent reports using 'low-dose' (0.5 units kg À1 per h) heparin. 4,5 Compared with reports by Uslu et al 4 and Shah et al, 5 however, the complication rates observed in the cohorts in both the epochs of this study were lower, and removal of heparin from continuous infusions did not result in an increased rate of occlusion or a decreased duration of use.…”

“…Although this practice is widespread, its clinical utility is controversial. [3][4][5][6][7][8] Heparin is listed as a 'high-alert' medication by the Institute for Safe Medication Practices because of a heightened risk of significant patient harm when used in error. 9 This is underscored by reports of adverse events from heparin in the neonatal period including heparin-induced thrombocytopenia, thrombosis, allergic reactions, drug incompatibility, iatrogenic intracranial hemorrhages in very low-birthweight (birthweight <1500 g) infants, 10,11 increased risk of candidemia 12 and failed response to indomethacin therapy for patent ductus arteriosus.…”

Cateter central de inserção periférica em neonato: revisão integrativa da literatura Central catheter of peripherally insertion in neonates: integrative literature review

“…28 In relation to care for maintaining the catheter they emphasized the use of heparin to prevent obstruction, aseptic dressing technique and the pressure applied to the catheter and prevent disruption. 19,21,26,29,34 The continuous infusion of low dose of heparin (0.5 IU/ kg/h) into the fluids is an effective measure to reduce the occlusion of the catheter, allowing the completion of therapy without observing adverse effects. 26,34 The healing practice is essential in maintaining the PICC because it covers and prevents local trauma and contamination, and respect the aseptic technique and the evidence as to the material used and the frequency of change.…”

“…19,21,26,29,34 The continuous infusion of low dose of heparin (0.5 IU/ kg/h) into the fluids is an effective measure to reduce the occlusion of the catheter, allowing the completion of therapy without observing adverse effects. 26,34 The healing practice is essential in maintaining the PICC because it covers and prevents local trauma and contamination, and respect the aseptic technique and the evidence as to the material used and the frequency of change. 21 In reporting experience with 491 catheters that evaluates technique of dressing with a protective base layer they concluded that catheter complication rates were low, and that dressing changes catheters wereminimized.…”

Colonización e infección en el neonato. ¿Hay un rol para el uso de la clorhexidina en la prevención de infecciones?

“…El uso de heparina y los catéteres impregnados con antibióticos para la prevención de las infecciones asociadas a dispositivos ha sido exitoso en algunos centros hospitalarios, pero su uso rutinario no está estandarizado. 3 Teniendo en cuenta que el neonato, desde el nacimiento, inicia un proceso de adquisición de flora normal que se altera en el medio hospitalario, el espectro de colonización de los recién nacidos que ingresan a la UCIN puede incluir flora potencialmente patógena, que puede ser la causa de infecciones graves. Por tanto, la posible prevención de la colonización por flora hospitalaria mediante la desinfección de la piel es de gran interés.…”