A Meta-Analysis of Effects of Heparin Flush and Saline Flush

Goode, Colleen J.; Titler, Marita G.; Rakel, Barbara A.; Ones, Deniz S.; Kleiber, Charmaine; Small, Susan; Triolo, Pamela Klauer

doi:10.1097/00006199-199111000-00002

Cited by 134 publications

(78 citation statements)

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“…Some studies investigating peripheral intravenous catheters have shown no difference in catheter maintenance with the use of heparin versus saline, although there are no studies to confirm these findings in children. [46][47][48] Controversy continues regarding optimal practices for CVC care. Some benefits associated with heparin prophylaxis include presumed improved CVC patency and decreased need for replacement catheters, although various risks have been demonstrated as well, such as heparin-induced thrombocytopenia, anaphylaxis, and bleeding as a result of errors in medication administration.…”

Section: Prophylaxismentioning

confidence: 99%

Thrombolytic therapy for central venous catheter occlusion

Baskin¹,

Reiss²,

Wilimas³

et al. 2011

Haematologica

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BackgroundLong-term central venous catheters have improved the quality of care for patients with chronic illnesses, but are complicated by obstructions which can result in delay of treatment or catheter removal. Design and MethodsThis paper reviews thrombolytic treatment for catheter obstruction. Literature from Medline searches using the terms "central venous catheter", "central venous access device" OR "central venous line" associated with the terms "obstruction", "occlusion" OR "thrombolytic" was reviewed. Efficacy of thrombolytic therapy, central venous catheter clearance rates and time to clearance were assessed. ResultsAlteplase, one of the current therapies, clears 52% of obstructed catheters within 30 min with 86% overall clearance (after 2 doses, when necessary). However, newer medications may have higher efficacy or shorter time to clearance. Reteplase cleared 67-74% within 30-40 min and 95% of catheters overall. Occlusions were resolved in 70 and 83% of patients with one and 2 doses of tenecteplase, respectively. Recombinant urokinase cleared 60% of catheters at 30 min and 73% overall. Alfimeprase demonstrated rapid catheter clearance with resolution in 40% of subjects within 5 min, 60% within 30 min, and 80% within 2 h. Additionally, urokinase prophylaxis decreased the incidence of catheter occlusions from 16-68% in the control group to 4-23% in the treatment group; in some studies, rates of catheter infections were also decreased in the urokinase group. ConclusionsThrombolytic agents successfully clear central venous catheter occlusions in most cases. Newer agents may act more rapidly and effectively than currently utilized therapies, but randomized studies with direct comparisons of these agents are needed to determine optimal management for catheter obstruction.

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Section: Prophylaxismentioning

confidence: 99%

Thrombolytic therapy for central venous catheter occlusion

Baskin¹,

Reiss²,

Wilimas³

et al. 2011

Haematologica

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“…Prosedyren med skylling av perifere venekatetre med heparin er nå endret ved vårt sykehus. Skylling med saltvann har vist seg å vaere like bra som skylling med heparin (21), samtidig som man unngår de alvorlige heparininduserte bivirkningene. De fleste andre sykehus i landet bruker kun saltvann til skylling av perifere venekatetre.…”

Section: Noe å Laere Avunclassified

En kvinne i 60-årene med store trombemasser i aorta

Hager

Nyquist²,

Jacobsen³

et al. 2015

Tidsskriftet

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“…12 Potentially, institutions might achieve a cost savings if heparincontaining solutions are not required for flushing. In a meta-analysis published in 1991, Goode et al 14 found that eliminating heparin flushes in patients with peripheral intravenous catheters could yield a potential yearly savings of $109 million to $218 million. At Barnes Jewish Hospital, the cost of a premade 10-mL solution with 10 units of heparin per milliliter is 45 cents each; in contrast, the cost of a premade 10-mL solution of physiological saline is 26 cents.…”

Section: Literature Reviewmentioning

confidence: 99%

National Survey of Central Venous Catheter Flushing in the Intensive Care Unit

Sona

Prentice

Schallom

2012

Critical Care Nurse

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Background Evidence is needed on the best solution for flushing central venous catheters. Objective To understand current flushing practices for short-term central venous catheters among critical care nurses before implementation of a randomized, controlled trial comparing physiological saline with heparin solution for flushing to maintain catheter patency. Methods A 6-item survey including demographic data was mailed to 2000 practicing critical care nurses in the United States. An additional 316 surveys were completed at the annual conference of the American Association of Critical-Care Nurses. Results Most (71.5%) of the 632 respondents who completed the survey were staff nurses. Most respondents (64.6%; 95% CI, 60.86%–68.34%) reported using physiological saline exclusively to flush central venous catheters and maintain patency. For heparin-containing solutions, the concentration and volume used varied. The most commonly reported volumes for flushing were 10 mL for saline (63%; 95% CI, 59.18%–66.82%) and 3 mL for heparin (50.2%; 95% CI, 43.5%–56.9%). Conclusion Flushing practices for central venous catheters vary widely. A randomized controlled trial is needed to determine the optimal flushing solution to maintain short-term patency.

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A Meta-Analysis of Effects of Heparin Flush and Saline Flush

Cited by 134 publications

References 0 publications

Thrombolytic therapy for central venous catheter occlusion

Thrombolytic therapy for central venous catheter occlusion

En kvinne i 60-årene med store trombemasser i aorta

National Survey of Central Venous Catheter Flushing in the Intensive Care Unit

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