Heparinized solution vs. saline solution in the maintenance of arterial catheters: a double blind randomized clinical trial

Cotillo, Mercedes Del; Grané, Nuria; Llavoré, Maria; Quintana, Salvador

doi:10.1007/s00134-007-0886-6

Cited by 53 publications

(54 citation statements)

References 10 publications

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“…11,12 In studies including newborns and patients in different age groups, heparin was shown to prolong the duration of peripheral catheter patency. [14][15][16][17] We found that average duration of the catheter use was significantly longer in heparin group (12.4±4.5 days vs 9.7±4.0 days). Similar to the results of Kamala et al 11 and Shah et al, 12 we showed that after completion of therapy, the likelihood of elective catheter removal (completed TPN therapy) was higher (53.5 vs 25.6%, P ¼ 0.001) and the incidence of catheter occlusion was lower in the heparin group (19.5 vs 45.5%, P ¼ 0.001).…”

Section: Discussionmentioning

confidence: 63%

The effect of low-dose heparin on maintaining peripherally inserted percutaneous central venous catheters in neonates

et al. 2010

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Objective: To evaluate the effect of low-dose heparin on duration of peripherally inserted percutaneous central venous catheter (PCVC) patency and catheter occlusion.Study Design: Our research was a prospective, randomized, controlled, double-blind clinical study including 246 eligible neonates with PCVCs. It was conducted at the neonatal intensive care unit (NICU) of Diyarbakir Children's Hospital between 1 February 2007 and 31 October 2008. In the heparin group (n ¼ 118), the total parenteral nutrition (TPN) solutions contained heparin, which was infused at a rate of 0.5 IU kg À1 h À1. The no-heparin group (n ¼ 121) received TPN fluids without heparin.Result: In the heparin group, the duration of catheter patency was longer than that of the no-heparin group reaching a statistically significant difference (12.4 ± 4.5 vs 9.7 ± 4.0, P<0.0001). In the heparin group, the proportion of patients completing the TPN therapy successfully was higher than in the no-heparin group (P ¼ 0.0001; relative risk (RR): 3.32 (95% confidence interval (CI): 1.92 to 5.73)) also demonstrating a statistically significant difference. The rate of catheter occlusion among infants in the heparin group was smaller (P ¼ 0.0001; RR: 3.44 (95% CI: 1.92 to 6.44)). There were no statistically significant differences between the two groups in the incidence of other catheter-related problems. The length of the occluded catheter outside the skin, TPN infusion rate and catheter duration time were found to be the factors associated with catheter occlusion. Heparin prevented catheter occlusion with a mechanism unrelated to these factors. Conclusion:In neonates with PCVCs, low-dose continuous infusion of heparin (0.5 IU kg À1 h À1 ) within TPN fluids is an effective measure in terms of reducing catheter occlusion, allowing successful completion of the therapy, without increasing adverse effects. Furthermore, this effect of heparin may occur independently via occlusion-related factors that we evaluated in the study.

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Section: Discussionmentioning

confidence: 63%

The effect of low-dose heparin on maintaining peripherally inserted percutaneous central venous catheters in neonates

et al. 2010

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“…Typically, diluted heparin is injected as a lock solution at the end of intravenous therapy to ensure device patency until the next drug administration. Several studies suggest that a 0.9% sodium chloride solution or normal saline (NS) is as effective as heparin in maintaining catheter patency in peripheral intravenous cannulas [1], arterial lines [2], apheresis [3], tunnelled, and non-tunnelled catheters [4]. For TIVADs, to the best of our knowledge, randomised studies comparing NS with the heparin lock are lacking.…”

Section: Introductionmentioning

confidence: 99%

Comparing normal saline versus diluted heparin to lock non-valved totally implantable venous access devices in cancer patients: a randomised, non-inferiority, open trial

et al. 2013

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“…Other, smaller, studies showed conflicting results. [7][8][9] Our observational study had a number of limitations. We did not control for potential differences between patients, locations, equipment, flush sets or practices regarding maintenance and removal of lines between institutions.…”

Section: Discussionmentioning

confidence: 99%

Observational Study of the Effect of Heparin-Containing Flush Solutions on the Incidence of Arterial Catheter Occlusion

Tully¹,

McGrath²,

Moore³

et al. 2014

Journal of the Intensive Care Society

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The National Patient Safety Agency (NPSA) highlighted potential dangers associated with arterial lines in 2008, recommending the use of saline-only flush solutions. The incidence of catheter thrombosis appeared to increase following the implementation of this guidance in some units. The objective of the current study was to observe local practice regarding the use of heparin in arterial catheter flush solutions, and subsequent arterial catheter occlusion rates. This was an observational study in which data were collected prospectively from 445 catheter insertions in unselected intensive care patients in eight member hospitals of the Association of North Western Intensive Care Units (ANWICU). Catheters flushed with heparinised solutions had a significantly increased median lifespan of 102 hours versus 72 hours for saline-flushed catheters (p<0.01). The likelihood of line blockage was significantly decreased in the heparin group (7.9%) compared with the saline group (41.2%, p<0.0001). Our results suggest that routine use of heparinised flush solutions is associated with increased catheter lifespan and reduced catheter thrombosis. We believe that there is justification for an adequately powered, randomised controlled trial. Current NPSA guidance may need to be reviewed.

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Heparinized solution vs. saline solution in the maintenance of arterial catheters: a double blind randomized clinical trial

Abstract: The use of heparinized solution for arterial catheter maintenance doesnot appear to be justified. It did not increase the duration of the catheters, nor did it improve their functionality significantly. On the other hand, heparin Na altered aPTT significantly.

Cited by 53 publications

References 10 publications

The effect of low-dose heparin on maintaining peripherally inserted percutaneous central venous catheters in neonates

The effect of low-dose heparin on maintaining peripherally inserted percutaneous central venous catheters in neonates

Comparing normal saline versus diluted heparin to lock non-valved totally implantable venous access devices in cancer patients: a randomised, non-inferiority, open trial

Observational Study of the Effect of Heparin-Containing Flush Solutions on the Incidence of Arterial Catheter Occlusion

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