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

Abstract

BackgroundHeparin saline (HS) is theoretically superior to normal saline (NS) for maintaining the patency of central venous catheters (CVCs), but the comparative efficacy of them remains controversial. The aim of this systematic review and meta-analysis was to assess the efficacy of NS versus HS in the maintenance of the patency of CVCs in adult patients.MethodsWe searched PubMed, Embase and the Cochrane library databases. Randomized controlled trials (RCTs) evaluating the use of NS vs. HS to maintain the permeability of CVCs among adult patients were included in our meta-analysis. References of relevant papers were reviewed manually. No language restriction was applied. Non-human studies were excluded. Pooled relative risk (RR) was calculated using a Mantel-Haenszel random-effects model. We also performed subgroup analysis examining the effect of the duration of catheter placement on the outcome. All statistical tests were two-sided using a significance level of 0.05.ResultsTen RCTs involving 7875 subjects (with analysis at patient, catheter, lumen and line access level) were included in this meta-analysis. Whether in terms of pooled or local analysis (RR with 95% confidence interval spans 1), NS can be equally, if not more effective, in keeping the CVCs open. Of studies reporting secondary outcomes (maneuver needed, heparin-induced thrombocytopenia, haemorrhage, central venous thrombosis and catheter-related bloodstream infection), heparinised saline was shown not to be superior to non-heparinised solution. Subgroup analysis in patients with short vs long term CVC placement was consistent with the main outcome partly and in particular for maintenance of catheter patency in patients with a long-term placement i.e. >30 days, the RR was 0.97 (n = 6589; 95% CI = 0.76 to 1.23; P = 0.796). However, for patients in whom the catheter was in place for <30 days, the RR was 1.52 (n = 1286; 95% CI = 1.02 to 2.27; P = 0.041).ConclusionsBased on the results of this meta-analysis, HS is not superior to NS in reducing CVCs occlusion. But in the short term, the use of HS is slightly superior to NS for flushing catheters from a statistical point of view.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-016-1585-x) contains supplementary material, which is available to authorized users.

Management and Prevention of Central Venous Catheter-Related Infections in the ICU

“…However, the role of heparin in preventing CR-BSI remained controversial: a recent meta-analysis showed that heparin saline is not superior to regular saline in reducing CR-BSI. 81 Data supporting the specific use of systemic anticoagulant therapy to prevent catheter-related thrombosis in ICU patients are scarce. In selected patient populations (e.g., cancer patients) with CVCs, anticoagulation administration should balance the possible benefit of reduced thromboembolic complications with the possible harms of anticoagulants.…”

Intravascular access devices from an interventional radiology perspective: indications, implantation techniques, and optimizing patency

“…If a patient has a heparin allergy, then normal saline may be used in its place. 63 The volume and concentration of heparin should be taken into consideration due to potential associated risks, including coagulation disorders, hypersensitivity reactions, and heparininduced thrombocytopenia. 63 The locking volume must be sufficient to fill each lumen of the catheter.…”

“…63 The volume and concentration of heparin should be taken into consideration due to potential associated risks, including coagulation disorders, hypersensitivity reactions, and heparininduced thrombocytopenia. 63 The locking volume must be sufficient to fill each lumen of the catheter. Because there is leaking of the lock over time into the vasculature, catheters should be overfilled by 15% to 20%.…”

Bedside Procedure: Retained Central Venous Catheter

“…Flushes are usually a sterile saline or heparin saline solution which is injected to fill the catheter. If an institution utilizes heparin saline for flushes, care should be exercised to identify patients with contraindications to heparin such as history of hypersensitivity reaction, and heparin-induced thrombocytopenia (HIT) [17][18][19]. There are many devices available for central venous access but they are generally composed of silicone or polyurethane which allows for relative stiffness at room temperature and a softened state at body temperature [6,11].…”