A Randomized, Controlled Trial of Heparin Versus Placebo Infusion to Prolong the Usability of Peripherally Placed Percutaneous Central Venous Catheters (PCVCs) in Neonates: The HIP (Heparin Infusion for PCVC) Study

Abstract

Heparin infusion prolonged the duration of peripherally inserted central venous catheter usability, which permitted a higher percentage of neonates to complete therapy without increasing adverse effects.

Effect of heparin and other factors associated with complications of peripherally inserted central venous catheters in neonates

“…These include catheter diameter (gauge), location of catheter tip, fluid infusion rate, dwell time, length of catheter outside the skin and precipitation of calcium and phosphate salts within the tubing. [4][5][6]8,15,16 Although the concentration of heparin used in the first epoch of this study (0.25 to 0.5 units ml À1 ) is low, the dose (0.5 to 2 units kg À1 per h) is comparable to recent reports using 'low-dose' (0.5 units kg À1 per h) heparin. 4,5 Compared with reports by Uslu et al 4 and Shah et al, 5 however, the complication rates observed in the cohorts in both the epochs of this study were lower, and removal of heparin from continuous infusions did not result in an increased rate of occlusion or a decreased duration of use.…”

“…1 However, complications such as occlusion, phlebitis, infection, accidental dislodgement, extravasation and leakage of fluid at catheter junctions proximal to the site of insertion occur with PICCs. [2][3][4][5][6] The identification of factors that are associated with these complications is important for patient safety and as quality improvement initiatives.…”

“…Although this practice is widespread, its clinical utility is controversial. [3][4][5][6][7][8] Heparin is listed as a 'high-alert' medication by the Institute for Safe Medication Practices because of a heightened risk of significant patient harm when used in error. 9 This is underscored by reports of adverse events from heparin in the neonatal period including heparin-induced thrombocytopenia, thrombosis, allergic reactions, drug incompatibility, iatrogenic intracranial hemorrhages in very low-birthweight (birthweight <1500 g) infants, 10,11 increased risk of candidemia 12 and failed response to indomethacin therapy for patent ductus arteriosus.…”

“…The duration of the use of PICCs in our unit was comparable to the duration reported in a clinical trial in which heparin was omitted from infusions through PICCs. 5 We hypothesized that the removal of heparin from continuous infusions through PICCs would have minimal impact on the incidence of catheter-associated complications and on the duration of the use of PICCs. This hypothesis was tested in a prospective assessment of PICC infusions without heparin.…”

Peripheral insertion of double-lumen central venous catheter using the Seldinger technique in newborns

“…2,11 Among the infectious complications, the incidence of catheterrelated sepsis with positive blood culture was lower than that reported in other studies in newborns. 2,4,[12][13][14][15] A possible explanation for this low incidence is that the indication for catheter placement in 12 cases was a previous episode of nosocomial sepsis requiring antimicrobial treatment and hemodynamic support and excluding the diagnosis of sepsis unless a different microorganism was detected in blood cultures. Positive catheter tip colonization was also in the low range of published data.…”