Normal saline (0.9% sodium chloride) versus heparin intermittent flushing for the prevention of occlusion in long-term central venous catheters in infants and children

Abstract

Cochrane Library Cochrane Database of Systematic Reviews Normal saline (0.9% sodium chloride) versus heparin intermittent flushing for the prevention of occlusion in long-term central venous catheters in infants and children (Review) Bradford NK, Edwards RM, Chan RJ Bradford NK, Edwards RM, Chan RJ. Normal saline (0.9% sodium chloride) versus heparin intermittent flushing for the prevention of occlusion in long-term central venous catheters in infants and children.

The efficacy of taurolidine containing lock solutions for the prevention of central-venous-catheter-related bloodstream infections: a systematic review and meta-analysis

“…Heparin locks however, do not have antimicrobial properties and current evidence suggests that regular saline locks might be as effective as heparin locks to maintain CVC patency. [7][8][9] A consensus meeting in 2016 reported that a lock solution containing taurolidine and/or citrate appears to be the most promising lock solution for the prevention of CVC-related bloodstream infections. [9] Taurolidine and citrate have antimicrobial, anti-biofilm and anticoagulant properties without reported antimicrobial resistance.…”

Routine Catheter Lock Solutions in Pediatric Cancer Care

“…Current nursing practices to prevent CVAD occlusion and other complications vary widely, because of the limited quality evidence to guide clinicians in the best practices for preventing occlusions and other CVAD adverse events 18 . We have demonstrated that we can (it is safe) and should (it is valuable) study catheter locks and other CVAD management practices in pediatric cancer care.…”

“…n Conclusion Current nursing practices to prevent CVAD occlusion and other complications vary widely, because of the limited quality evidence to guide clinicians in the best practices for preventing occlusions and other CVAD adverse events. 18 We have demonstrated that we can (it is safe) and should (it is valuable) study catheter locks and other CVAD management practices in pediatric cancer care. In particular, future studies should extend the follow-up period and revise exclusion criteria to include children receiving PEGasparaginase, and regional centers and home care services, where patients could most benefit from an efficient lock solution between cancer treatments across populations.…”

“…[15][16][17] Historically low-dose heparin (10-100 U/mL) was instilled, then was aspirated before the next therapy administration, and was primarily selected because of its anticoagulant properties. 18 However, the effectiveness of heparin to prevent thrombotic occlusion for extended periods is questionable, given its short halflife (60-90 minutes). 19 In addition, there is a risk of bleeding due to accidental administration of heparin during the aspiration procedure or overdose due to incorrect dilution.…”

Improving management of fever in neutropenic children with cancer across multiple sites

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Children with cancer are at high risk of infection because of chemotherapeutic treatment, subsequent immune suppression as well as the common use of central venous access devices (Bradford et al, 2020;Green & Aarons, 2011;Lehrnbecher et al, 2012). An estimated 30% of all cases of chemotherapy-induced neutropenia in children with cancer are associated with fever, which may be the only sign of underlying severe infection, a potentially lethal complication of treatment (Agyeman et al, 2011;Hausler, 2020).

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