Heparin versus 0.9% saline solution to maintain patency of totally implanted venous access ports in cancer patients: A systematic review and meta‐analysis

Abstract

Aim The use of heparin and 0.9% saline solution is always controversial for central venous catheters. However, there is no systematic review or guideline about whether saline solution can replace heparin solution in adult cancer patients with totally implantable venous access ports (TIVAPs). The purpose of this review is to evaluate whether saline solution can replace heparin saline to lock TIVAPs. Methods The following databases were searched: PubMed, the Cochrane Library, Web of Science, Embase, CINAHL and Ovid (January 1, 1982, and February 21, 2020). All statistical analyses of the meta‐analysis were completed using the Review Manager 5.3. Results A total of 201 studies were identified from these databases after initial review, and four studies met inclusion criteria, including 2652 cases. There was little heterogeneity among the included studies (I2 < 30%), and all analyses were conducted by the fixed‐effects model. The total complications, catheter occlusions, catheter‐related bloodstream infections and other complication rates in the heparin solution group were higher than in the saline solution group. In the subgroup analysis of heparin concentration, total complication rates in the saline solution group were higher than with 50 U of heparin and lower than with 100 U of heparin. However, the differences in these complications were small, and no significant difference was observed (all P > 0.05). Conclusions Based on existing clinical studies, we recommend that saline solution can replace 50 or 100 U/ml of heparin as a safe and effective flush solution for TIVAPs.

The effect of chemotherapy type and timing among the other factors on patency of totally implantable vascular access devices in colorectal carcinoma

“…6,26 Fourth, we chose to use heparinized 0.9% NaCl solution before insertion, but used 0.9% NaCl after each treatment and every month thereafter. In 2021, Wu et al 27 suggested that there was no difference between 1/10 heparinized and non-heparinized NaCl solutions. Guidelines for TIVAD recently prefer non-heparinized NaCl solution.…”

Heparin versus normal saline for the care of peripheral intravenous catheters in pediatrics: a meta-analysis of randomized controlled trials

“…Its advantage is that the use is not limited by the type of disease. It is especially suitable for patients with bleeding tendency, disturbance of blood coagulation mechanism and insufficiency of liver and kidney [ 11 ]. Heparin sodium is a highly effective anticoagulant, it has been reported that heparin sodium can reduce venous thrombosis and maintain vascular patency [ 12 ].…”

Administration of 4% tetrasodium EDTA lock solution and central venous catheter complications in high‐risk pediatric patients with intestinal failure: A retrospective cohort study

“…[20][21][22] In fact, heparin use as a catheter lock solution is a risk factor for biofilm formation and infections. [23][24][25] Access to ELT has also been inconsistent because of changes in price and availability, leaving high-risk patients with no antimicrobial alternative. 26 European guidelines recommend the use of taurolidine locks for secondary prevention of CLABSI.…”

“…Heparin is less effective for infection prophylaxis in patients with intestinal failure and ELT increases the rate of mechanical complications 20–22 . In fact, heparin use as a catheter lock solution is a risk factor for biofilm formation and infections 23–25 . Access to ELT has also been inconsistent because of changes in price and availability, leaving high‐risk patients with no antimicrobial alternative 26 .…”