Benefit of heparin in peripheral venous and arterial catheters: systematic review and meta-analysis of randomised controlled trials

Randolph, Adrienne G.; Cook, Deborah J.; Gonzales, Calle A.; Andrew, Maureen

doi:10.1136/bmj.316.7136.969

Cited by 182 publications

(77 citation statements)

References 34 publications

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“…220 In addition, there is a reported association between thrombosis and peripherally inserted catheter-associated bloodstream infection in neonates (n=882 neonates, 1540 peripherally inserted catheters; P<0.05). 221 Although not reported, likely because of low numbers, there may also be an increased risk of shunt thrombosis in neonates with infection.…”

Section: Incidence Prevention and Treatment Of Thrombosis In Childrmentioning

confidence: 99%

Prevention and Treatment of Thrombosis in Pediatric and Congenital Heart Disease

Giglia¹,

Massicotte²,

Tweddell³

et al. 2013

Circulation

298

245

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Section: Incidence Prevention and Treatment Of Thrombosis In Childrmentioning

confidence: 99%

Prevention and Treatment of Thrombosis in Pediatric and Congenital Heart Disease

Giglia¹,

Massicotte²,

Tweddell³

et al. 2013

Circulation

298

245

View full text Add to dashboard Cite

“…12 Another possible explanation is the evidence that heparin and physiological saline are associated with similar rates of thrombosis for shorter length peripheral venous and arterial catheters with shorter dwell times. 6 Last, the recommended use of a heparin solution rather than saline for flushing is considered inconclusive in guidelines for maintenance of short-term CVCs. 3 The percentage of respondents who used heparin-containing flush solutions was higher for the 64 advanced practice nurses (clinical nurse specialists, nurse practitioners, or educators) than for the other groups.…”

Section: Discussionmentioning

confidence: 99%

“…Care of peripherally placed central catheters, introducer sheaths, and dialysis catheters was excluded because practice patterns and guidelines vary with different types of catheters. [3][4][5][6][7][8] In addition, one of the authors (D.P.) is a member of a 13-hospital system intravenous products committee and therefore had extensive knowledge of the various needleless devices available on the market, knowledge that contributed to the face validity of the survey.…”

Section: Methodsmentioning

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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“…2 One meta-analysis performed in 1998 demonstrated an increased longevity of lines flushed with HS. 7 This included one of the largest studies to date -a multicentre unblinded randomised control trial from the American Association of Critical Care Nurses. The study of 5139 subjects concluded that HS lines had a higher probability of remaining patent, compared to those flushed with NS.…”

Section: Discussionmentioning

confidence: 99%

Finding a solution: Heparinised saline versus normal saline in the maintenance of invasive arterial lines in intensive care

Everson

Webber

Penfold

et al. 2016

Journal of the Intensive Care Society

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Background:We assessed the impact of heparinised saline versus 0.9% normal saline on arterial line patency. Maintaining the patency of arterial lines is essential for obtaining accurate physiological measurements, enabling blood sampling and minimising line replacement. Use of heparinised saline is associated with risks such as thrombocytopenia, haemorrhage and mis-selection. Historical studies draw variable conclusions but suggest that normal saline is at least as effective at maintaining line patency, although recent evidence has questioned this. Methods: We conducted a prospective analysis of the use of heparinised saline versus normal saline on unselected patients in the intensive care of our hospital. Data concerning duration of 471 lines insertion and reason for removal was collected. Results: We found a higher risk of blockage for lines flushed with normal saline compared with heparinised saline (RR ¼ 2.15, 95% CI 1.392-3.32, p 4 0.001). Of the 56 lines which blocked initially (19 heparinised saline and 37 normal saline lines), 16 were replaced with new lines; 5 heparinised saline lines and 11 normal saline lines were reinserted; 5 of these lines subsequently blocked again, 3 of which were flushed with normal saline. Conclusions: Our study demonstrates a clinically important reduction in arterial line longevity due to blockages when flushed with normal saline compared to heparinised saline. We have determined that these excess blockages have a significant clinical impact with further lines being inserted after blockage, resulting in increased risks to patients, wasted time and cost of resources. Our findings suggest that the current UK guidance favouring normal saline flushes should be reviewed.

show abstract

Benefit of heparin in peripheral venous and arterial catheters: systematic review and meta-analysis of randomised controlled trials

Cited by 182 publications

References 34 publications

Prevention and Treatment of Thrombosis in Pediatric and Congenital Heart Disease

Prevention and Treatment of Thrombosis in Pediatric and Congenital Heart Disease

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

Finding a solution: Heparinised saline versus normal saline in the maintenance of invasive arterial lines in intensive care

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