Flushing the Central Venous Catheter: Is Heparin Necessary?

Abstract

There is no evidence of a different effectiveness between heparin flushing and normal saline or other solutions in reducing catheter occlusions. Due to the little and inconclusive evidence available in this field, further studies might be necessary.

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

“…The result of the first study (network meta-analysis) was no marked difference, when comparing adult patients with NS vs HS or other solutions in the flushing of CVCs [33]. The second study, consistent with results of previous research, found that HS was not more effective than NS in reducing catheter occlusion when analysed in three different areas (participant, catheter and line access) [18].…”

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

“…Historically, heparin solution has been the most commonly used method to maintain catheter patency, dating back to the 1970s (1) . However, this practice seems to have concealed its negative effects (1,3) , of which we can highlight the iatrogenic effects of the drug itself, such as thrombocytopenia.…”

“…Although on the one hand its use has enabled therapeutic advances, it has also led to the origin of various associated risks, of which infection and catheter obstruction (1)(2)(3)(4) can be highlighted; factors contributing to an increase of hospital internalizations, morbidity and hospitalization costs (4) . For these reasons, CVC handling, maintenance and optimization is complicit to the predominant value of care, where nurses must gather a body of knowledge and skills to ensure proper handling of the CVC (5) .…”

“…Thrombocytopenia associated with the administration of heparin is developed in about 1-5% of the exposed population, and it is recognized that intravenous exposure to heparin alone is a predictive factor for developing thrombocytopenia (7)(8) . From a macro perspective, indiscriminate use of heparin for CVC also has negative economic and social consequences when compared with the use of saline solution, because the obstruction of CVC implies an interruption of therapeutic treatments and an increase in the risks associated with catheterization for the patient, which becomes more important in the aspect of quality healthcare (3) . We cannot help but reflect on the different focuses that are necessary in this practice of nursing: thrombocytopenia is related to the frequent use of heparin; thrombocytopenia risk exists even when the exposure is minimal; heparin is found in various concentrations and formulations, increasing the risk of error in dilution preparation; and several studies have suggested that heparin is related to medication errors (1,3) .…”

“…From a macro perspective, indiscriminate use of heparin for CVC also has negative economic and social consequences when compared with the use of saline solution, because the obstruction of CVC implies an interruption of therapeutic treatments and an increase in the risks associated with catheterization for the patient, which becomes more important in the aspect of quality healthcare (3) . We cannot help but reflect on the different focuses that are necessary in this practice of nursing: thrombocytopenia is related to the frequent use of heparin; thrombocytopenia risk exists even when the exposure is minimal; heparin is found in various concentrations and formulations, increasing the risk of error in dilution preparation; and several studies have suggested that heparin is related to medication errors (1,3) . On the other hand, some studies suggest that saline flush is cost-effective, adequate and also has the benefit of not having the adverse effects of heparin and not having several presentations nor preparation required at different concentrations (2,(9)(10)(11)(12)(13)(14) .…”