Routine Catheter Lock Solutions in Pediatric Cancer Care

Abstract

Background: Central venous access devices (CVADs) are integral to cancer care provision. Despite the high prevalence of CVAD complications in children with cancer, preventative strategies are understudied. Objective: The aim of this study was to assess study feasibility, occlusive events, thrombolytic use, adverse events, and direct costs of catheter lock solutions. Methods: A single-center, parallel-group, pilot randomized controlled trial was undertaken at a tertiary-referral pediatric hospital in Australia.Children 18 years or younger with an oncological or malignant hematological condition and a CVAD were eligible. Participants were 1:1 randomized to (1) normal or ( 2) heparinized (10-100 U/mL; CVAD-type dependent) saline lock solutions. Results: Of 217 children assessed for eligibility, 61 were recruited and randomized to normal (n = 30; 3850 CVAD days) or heparinized (n = 31; 4036 CVAD days) saline. Eligibility (52%) and recruitment (54%) feasibility targets were not met. Protocol adherence was high (95% assessments), with no attrition. Parent/clinician satisfaction of interventions was high (median, 10/10 clinicians/parents). Complete CVAD occlusion occurred in heparin only (n = 2, 6.7% CVADs; incidence rate [IR], 0.49/1000 CVAD days [0.06-1.78]). Central venous access device partial occlusion was detected in 23.3% of CVADs in heparin (n = 7; IR, 2.73/1000 CVAD days [1.36-4.87]) and 13.8% of CVADs in normal saline (n = 4; IR, 2.59/1000 CVAD days [1 .24-4.77]). Thrombolytic agents were used in 16.7% heparin (5 CVADs) and 3.5% normal saline (1 CVAD). Adverse events did not differ between groups. Conclusion: Multisite randomized controlled trials examining CVAD locks are safe, but strategies and resources to increase recruitment and eligibility are required. Implications for Practice: Both routine CVAD lock solutions seem safe but may not prevent all forms of CVAD-associated harm.

Association between 4%‐tetrasodium EDTA and sepsis in neonatal piglets: A retrospective cohort study

“…33 Heparin also has a low half-life of 60-90 min. 34 In addition, there is the potential for heparin-induced thrombocytopenia along with stimulating biofilm formation at high doses. 18,35,36 A limitation of this animal study was the retrospective nature, happen after day 7 in our studies, presumably the time for biofilm and thrombus formation.…”

“…Unfortunately, there is no evidence of heparin preventing infection 33 . Heparin also has a low half‐life of 60–90 min 34 . In addition, there is the potential for heparin‐induced thrombocytopenia along with stimulating biofilm formation at high doses 18,35,36 …”

Heparin versus normal saline for the care of peripheral intravenous catheters in children: A meta‐analysis

“…It has been recommended that strengthen the professional training of nursing staff in the department, unify the standard, reduce the operation error, improve the success rate of puncture and reduce the incidence of local complications. The blockage of the catheter directly affects the indwelling time, and the selection of appropriate sealing solution is the key to reduce the incidence of blockage (Ullman et al, 2022).…”

“…It has been recommended that strengthen the professional training of nursing staff in the department, unify the standard, reduce the operation error, improve the success rate of puncture and reduce the incidence of local complications. The blockage of the catheter directly affects the indwelling time, and the selection of appropriate sealing solution is the key to reduce the incidence of blockage (Ullman et al., 2022 ). Some studies (Greene, 2021 ; Schroeder & Davis, 2020 ) suggest that the lock solution of peripheral indwelling needle in children should use normal saline because its osmotic pressure is equal to that of blood osmotic pressure.…”

Variation in central venous catheter care and management: a review of UK paediatric oncology principal treatment centre practice

“…Our audit has shown there is no standardised practice for CVC care and management across UK PTCs. The evidence for the benefit of heparin and saline for flushing or different ANTT techniques is limited by heterogenous studies 1–3. We did not ascertain the rate of central line-associated bloodstream infections or CVC complications in this audit to assess whether the different cares had an impact on this but this is important to consider in a clinical trial setting 4.…”