Normal saline versus heparin solution to lock totally implanted venous access devices: Results from a multicenter randomized trial

Molin, Alberto Dal; Clerico, Mario; Baccini, Michela; Guerretta, Linda; Sartorello, Barbara; Rasero, Laura

doi:10.1016/j.ejon.2015.04.001

Cited by 34 publications

(38 citation statements)

References 21 publications

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“…<30 and >30 days). Our results, in accordance with current studies, meta-analyses and reviews [18, 27, 33], suggest that there is very little evidence to conclude that flushing with HS has more effect than NS flushing solution for CVC maintenance.…”

Section: Discussionsupporting

confidence: 90%

“…Thus, a total of 10 studies were eligible according to the inclusion criteria. The 10 studies were from Germany [13] ( n = 1), Spain [6] ( n = 1), Belgium [26] ( n = 1), Italy [27] ( n = 1), Japan [28] ( n = 1), Iran [29, 30] ( n = 2) and the USA [2, 31, 32] ( n = 3). As a result, the 10 trials, including four ICU and six non-ICU studies, were reported in the years 2002–2015 and the average duration of follow up ranged from 1 to 400 days.…”

Section: Resultsmentioning

confidence: 99%

“…2. It indicated that two papers had high risk of bias as they failed to obtain the expected sample size [6, 27], and one study was subject to detection bias, as the outcome measurement could have been influenced by lack of blinding [27].

Fig.…”

Section: Resultsmentioning

confidence: 99%

“…In particular, catheter survival rate was higher in the HS group than in NS group. In contrast to the results of the Rabe study, a large number of other studies suggest that the catheter lumen occlusion rate is not different between those with vs those without heparin [10, 27–29]. NS flushing for CVCs has been applied in some American ICUs without supporting evidence [35].…”

Section: Discussionmentioning

confidence: 99%

“…Parallel with the mainstream view, Schiffer et al [17] suggest that routine flushing of CVCs with NS to prevent occlusion is reasonable in this guideline. Morover, a report of a recent multicentre randomized trial [27] argued that HS was not more effective than NS in reducing withdrawal or total occlusion. No statistical difference in catheter patency was observed when comparing NS to HS solution.…”

Section: Discussionmentioning

confidence: 99%

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

Zhong

Wang²,

et al. 2017

Crit Care

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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.

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Section: Discussionsupporting

confidence: 90%