Surface heparinization of central venous catheters reduces microbial colonization in vitro and in vivo

Appelgren, Pia; Ransjö, Ulrika; Bindslev, L.; Espersen, Frank; Larm, Olle

doi:10.1097/00003246-199609000-00009

Cited by 146 publications

(67 citation statements)

References 32 publications

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“…[12][13][14] There are many hypotheses about how heparin reduces bacterial adhesion; in an environment with a low protein content such as urinary tract, the effect of heparin could result from its hydrophobicity and negative charge. 14 Ruggieri and associates 14 showed a 90% reduction of bacterial adhesion on heparin-coated catheter surfaces, while Hildebrandt and colleagues 13 demonstrated reductions in stent encrustation by heparin coating in another study.…”

Section: Discussionmentioning

confidence: 99%

“…[7][8][9][10][11] Heparin coating was proposed to prevent bacterial adhesion over the last three decades, especially in vascular medicine. [12][13][14] Heparin is an anticoagulant that carries a strong negative electrical charge and helps prevent cell adhesion. For this reason, heparinization can be a practical and low-cost approach to the prevention of catheter-associated bacteremia or fungemia.…”

Section: Introduction Umentioning

confidence: 99%

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Heparin Coating on Ureteral Double J Stents Prevents Encrustations: An in Vivo Case Study

Cauda

Fiori

et al. 2008

Journal of Endourology

100

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Purpose:To evaluate the ability of heparin coating to inhibit Double J stent encrustation and compare it with the classic polyurethane Double J stent.Patients and Methods: The study involved five patients with bilateral obstructions, who required bilateral ureteral Double J stent placement. Every patient received a heparin-coated Double J stent and a traditional polyurethane Double J stent for 1 month. After removal, the stents were analyzed using field emission scanning electron microscopy (FESEM), energy dispersive spectroscopy (EDS). and micro-infrared spectrophotometry (Micro-IR). These same techniques were used to analyze the heparin-coated and uncoated stents before insertion. The thickness, extension, and composition of encrustation of the coated and uncoated stents were compared. Moreover, two heparin-coated stents were analyzed with the same techniques after they had been in place for 10 and 12 months.Results: FESEM analysis showed that the difference in encrustation thickness and extension between the two groups was significant. EDS and Micro-IR confirmed that in the heparinized stents the encrustations were not as uniform and compact as those in the uncoated stents. The stents that were left in place long-term were free of encrustations and had no changes in the heparin layer.Conclusions: Heparin coating reduces stent encrustation. Moreover, as no changes were seen in the heparin layer, we concluded that covalent heparin bonding enhances its adhesion to the polyurethane surface and ensures its stability for long periods. The heparin-coated stent appears to be a useful tool for long-term urinary drainage.

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Section: Discussionmentioning

confidence: 99%

Section: Introduction Umentioning

confidence: 99%

Heparin Coating on Ureteral Double J Stents Prevents Encrustations: An in Vivo Case Study

Cauda

Fiori

et al. 2008

Journal of Endourology

100

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“…Reason for exclusion Geffers, 2003 102 Review of the methodological quality of the trials available in this area of research Mermel, 2000 103 All CRBSI preventive strategies Zurcher, 2004 106 Compared single and multilumen CVCs Saint, 2000 40 Clinical and economic consequences of nosocomial CVC-related infection Bambauer, 2004 101 Narrative overview Raad, 1999 104 Narrative overview Sherertz, 2004 105 Narrative overview 3 Maki, 1988 75 Cuff vs non-cuffed ✓ ✓ Flowers, 1989 108 Cuff vs non-cuffed ✓ ✓ Kamal, 1991 109 In-house preparation ✓ ✓ ✓ of AI-CVCs Groeger, 1993 110 Cuff vs 2nd cuff ✓ ✓ Babycos, 1993 72 ✓ Bach, 1994 98 Interim results ✓ ✓ Ramsay, 1994 99 Interim results ✓ ✓ Dahlberg, 1995 111 Silver cuff vs non-cuffed ✓ Goldschmidt, 1995 112 German ✓ ✓ ✓ Smith, 1995 113 Cuff vs non-cuffed ✓ ✓ Trazzera, 1995 114 Non-RCT ✓ ✓ Appelgren, 1996 115 Standard CVC vs ✓ heparin-bonded CVC Bach, 1996 53 In-house preparation ✓ ✓ of AI-CVCs reviewed. Below are some of the issues that were raised by the reviews.…”

Section: Appendixmentioning

confidence: 99%

The clinical effectiveness and cost-effectiveness of central venous catheters treated with anti-infective agents in preventing bloodstream infections: a systematic review and economic evaluation

Hockenhull¹,

Dwan²,

Boland³

et al. 2008

Health Technol Assess

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Non-UK purchasers will have to pay a small fee for post and packing. For European countries the cost is £2 per monograph and for the rest of the world £3 per monograph.You can order HTA monographs from our Despatch Agents:-fax (with credit card or official purchase order) -post (with credit card or official purchase order or cheque) -phone during office hours (credit card only).Additionally the HTA website allows you either to pay securely by credit card or to print out your order and then post or fax it. NHS libraries can subscribe free of charge. Public libraries can subscribe at a very reduced cost of £100 for each volume (normally comprising 30-40 titles). The commercial subscription rate is £300 per volume. Please see our website for details. Subscriptions can only be purchased for the current or forthcoming volume. Contact details are as follows: Payment methods Paying by chequeIf you pay by cheque, the cheque must be in pounds sterling, made payable to Direct Mail Works Ltd and drawn on a bank with a UK address. Paying by credit cardThe following cards are accepted by phone, fax, post or via the website ordering pages: Delta, Eurocard, Mastercard, Solo, Switch and Visa. We advise against sending credit card details in a plain email. Paying by official purchase orderYou can post or fax these, but they must be from public bodies (i.e. NHS or universities) within the UK. We cannot at present accept purchase orders from commercial companies or from outside the UK. How do I get a copy of HTA on CD?Please use the form on the HTA website (www.hta.ac.uk/htacd.htm). Or contact Direct Mail Works (see contact details above) by email, post, fax or phone. HTA on CD is currently free of charge worldwide.The website also provides information about the HTA Programme and lists the membership of the various committees. HTA NIHR Health Technology Assessment ProgrammeT he Health Technology Assessment (HTA) Programme, part of the National Institute for Health Research (NIHR), was set up in 1993. It produces high-quality research information on the effectiveness, costs and broader impact of health technologies for those who use, manage and provide care in the NHS. 'Health technologies' are broadly defined as all interventions used to promote health, prevent and treat disease, and improve rehabilitation and long-term care. The research findings from the HTA Programme directly influence decision-making bodies such as the National Institute for Health and Clinical Excellence (NICE) and the National Screening Committee (NSC). HTA findings also help to improve the quality of clinical practice in the NHS indirectly in that they form a key component of the 'National Knowledge Service'. The HTA Programme is needs-led in that it fills gaps in the evidence needed by the NHS. There are three routes to the start of projects. First is the commissioned route. Suggestions for research are actively sought from people working in the NHS, the public and consumer groups and professional bodies such as royal colleges and NHS trusts. These sugges...

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“…The intraluminal thrombus acts as a nidus for the catheter biofilm, and in vitro studies have shown decreased adherence of bacteria to heparin-coated catheters compared with noncoated catheters (5). Moreover, two randomized clinical trials in hospitalized patients with short-term, nontunneled central vein catheters found a lower risk of catheter-related bacteremia in patients with heparincoated catheters (5,6).…”

mentioning

confidence: 99%

Does Heparin Coating Improve Patency or Reduce Infection of Tunneled Dialysis Catheters?

Jain¹,

Allon²,

Saddekni

et al. 2009

Clinical Journal of the American Society of Nephrology

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Background and objectives: Tunneled dialysis catheters are prone to frequent malfunction and infection. Catheter thrombosis occurs despite prophylactic anticoagulant locks. Catheter thrombi may also serve as a nidus for catheter infection, thereby increasing the risk of bacteremia. Thus, heparin coating of catheters may reduce thrombosis and infection. This study evaluated whether heparin-coated hemodialysis catheters have fewer infections or greater cumulative survival than noncoated catheters.Design, setting, participants, & measurements: We retrospectively queried a prospective access database to analyze the outcomes of 175 tunneled dialysis catheters placed in the internal jugular vein, including 89 heparin-coated catheters and 86 noncoated catheters. The primary outcome was cumulative catheter survival, and the secondary outcome was infection-free catheter survival.Results: The two patient groups were similar in demographics and clinical and catheter features. Catheter-related bacteremia occurred less frequently with heparin-coated catheters than with noncoated catheters (34 versus 60%, P < 0.001). Cumulative catheter survival was similar in heparin-coated and noncoated catheters (hazard ratio, 0.87; 95% confidence interval, 0.55 to 1.36; P ‫؍‬ 0.53). On multiple variable survival analysis including catheter type, age, sex, diabetes, coronary artery disease, peripheral vascular disease, cerebrovascular disease, catheter location, and previous catheter, only catheter location predicted cumulative catheter survival (hazard ratio, 2.03; 95% CI, 1.27 to 3.25, with the right internal jugular location being the reference group, P ‫؍‬ 0.003). The frequency of thrombolytic instillation was 1.8 per 1000 catheter-days in both groups.Conclusions: Heparin coating decreases the frequency of catheter-related bacteremia but does not reduce the frequency of catheter malfunction.

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Surface heparinization of central venous catheters reduces microbial colonization in vitro and in vivo

Abstract: Covalent end point surface heparinization appears to have a great impact on both in vitro and in vivo bacterial colonization of central venous catheters. Such heparinization can be a practical and economical approach to the prevention of catheter-associated bacteremia or fungemia.

Cited by 146 publications

References 32 publications

Heparin Coating on Ureteral Double J Stents Prevents Encrustations: An in Vivo Case Study

Heparin Coating on Ureteral Double J Stents Prevents Encrustations: An in Vivo Case Study

The clinical effectiveness and cost-effectiveness of central venous catheters treated with anti-infective agents in preventing bloodstream infections: a systematic review and economic evaluation

Does Heparin Coating Improve Patency or Reduce Infection of Tunneled Dialysis Catheters?

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