Effectiveness of heparin versus 0.9% saline solution in maintaining the permeability of central venous catheters: a systematic review

Santos, Eduardo; Cunha, Madalena; Cardoso, Daniela; Apóstolo, João; Queirós, Paulo Joaquím Pina; Rodrigues, Manuel Alves

doi:10.1590/s0080-623420150000600017

Cited by 20 publications

(19 citation statements)

References 28 publications

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“…These findings challenged the continued use of HS in CVC flushing, as it is more expensive than saline solution. However, a recent study supported NS as a substitution for HS as a locking solution in CVCs in adult patients from the point of view of four different types of CVC [34]. Data from these studies suggests that HS may not be required to maintain the patency of CVCs.…”

Section: Discussionmentioning

confidence: 99%

Normal saline versus heparin for patency of central venous catheters in adult patients - a systematic review and meta-analysis

Zhong

Wang²,

et al. 2017

Crit Care

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BackgroundHeparin saline (HS) is theoretically superior to normal saline (NS) for maintaining the patency of central venous catheters (CVCs), but the comparative efficacy of them remains controversial. The aim of this systematic review and meta-analysis was to assess the efficacy of NS versus HS in the maintenance of the patency of CVCs in adult patients.MethodsWe searched PubMed, Embase and the Cochrane library databases. Randomized controlled trials (RCTs) evaluating the use of NS vs. HS to maintain the permeability of CVCs among adult patients were included in our meta-analysis. References of relevant papers were reviewed manually. No language restriction was applied. Non-human studies were excluded. Pooled relative risk (RR) was calculated using a Mantel-Haenszel random-effects model. We also performed subgroup analysis examining the effect of the duration of catheter placement on the outcome. All statistical tests were two-sided using a significance level of 0.05.ResultsTen RCTs involving 7875 subjects (with analysis at patient, catheter, lumen and line access level) were included in this meta-analysis. Whether in terms of pooled or local analysis (RR with 95% confidence interval spans 1), NS can be equally, if not more effective, in keeping the CVCs open. Of studies reporting secondary outcomes (maneuver needed, heparin-induced thrombocytopenia, haemorrhage, central venous thrombosis and catheter-related bloodstream infection), heparinised saline was shown not to be superior to non-heparinised solution. Subgroup analysis in patients with short vs long term CVC placement was consistent with the main outcome partly and in particular for maintenance of catheter patency in patients with a long-term placement i.e. >30 days, the RR was 0.97 (n = 6589; 95% CI = 0.76 to 1.23; P = 0.796). However, for patients in whom the catheter was in place for <30 days, the RR was 1.52 (n = 1286; 95% CI = 1.02 to 2.27; P = 0.041).ConclusionsBased on the results of this meta-analysis, HS is not superior to NS in reducing CVCs occlusion. But in the short term, the use of HS is slightly superior to NS for flushing catheters from a statistical point of view.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-016-1585-x) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Normal saline versus heparin for patency of central venous catheters in adult patients - a systematic review and meta-analysis

Zhong

Wang²,

et al. 2017

Crit Care

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“…Among these assignments, it is important to note the indispensability of their participation in raising awareness among professionals about the rationalization of expenditures, aiming at minimal waste of resources and commitment with the assistance provided 15 .…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, its systemic effects may cause a problem as they contribute to the development of thrombocytopenia. In contrast, the use of sodium chloride 0.9% has been considered adequate, without significant differences in effectiveness when compared with heparin, and posing a lower risk of complications to the patients 16 .…”

Section: Discussionmentioning

confidence: 99%

Direct cost of maintenance of totally implanted central venous catheter patency

Homo

Lima

2018

Rev. Latino-Am. Enfermagem

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Objective:to identify the average direct cost of maintaining the patency of totally implanted central venous catheter with heparin at a Day Hospital of a public hospital of high complexity specialized in the treatment of cancer patients, and estimate the average direct cost of replacing heparin with sodium chloride 0.9%. Method:quantitative, exploratory-descriptive study, with a sample of 200 non-participant observations of the maintenance of totally implanted central venous catheters with heparin. The average direct cost was calculated by multiplying the (clocked) time spent by professionals to complete the procedure by the direct unit cost of workforce, added to the cost of materials and solutions. Results:the estimated total direct cost of catheter maintenance with heparin was US$ 9.71 (SD=1.35) on average, ranging from US$ 7.98 to US$ 23.28. The estimated total direct cost of maintenance with 0.9% sodium chloride in the place of heparin was US$ 8.81 (SD=1.29) on average, resulting in a reduction of US$ 0.90 per procedure. Conclusion:the results contributed to propose strategies to assist in cost containment/minimization in this procedure. The replacement of heparin by 0.9% sodium chloride proved to be an option to reduce the total average direct cost.

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“…and routine positive pressure washing of the CVC-TI with a saline solution to fill its light in order to keep it clear even when not in use for up to 30 days (if there is no prescription/indication of CVC-TI fluid infusion for up to 90 days). 5,24 Studies mention that, within up to three months, maintenance with a saline solution using the positive pressure technique does not interfere with CVC-TI permeability and allows even greater patient/client safety. 5,[25][26][27] CVC-TI flush aims to remove possible deposits of fibrin, drugs, viscous products, blood components and other compounds that adhere inside and in the subcutaneous reservoir; thus, about 20 mL is recommended for effective CVC-TI washing.…”

Section: /16mentioning

confidence: 99%

Care Protocol With Totaly Implanted Venous Catheter: A Collective Construction

Fonseca

Oliveira

Amaral

et al. 2019

Texto contexto - enferm.

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Objective: to collectively construct a fully implanted central venous catheter care protocol with nurses from a highly complex oncology center. Method: a convergent care research, conducted at a hospital qualified as a highly complex oncology care unit in Minas Gerais, Brazil, from September 2017 to January 2018. The construction of the protocol was guided by Evidence Based Practice. Initially, data was collected from client records. After that, five workshops were held with the nurses, aiming to verify the material and human resources available, besides the viable care to compose the protocol. The analysis involved processes of apprehension, synthesis, theorization and transference. Results: most of the 219 medical records evaluated from clients with fully implanted venous catheters were female (77.1%), with a mean age 49.6 years old, breast cancer, and average catheter stay of 502 days. The nurses participating in the research were female, with a mean age 30.2 years old, time since graduation of 5.2 years and experience in oncology of 4.8 years on average. During the workshops, the participants reflected on the daily routine of the service, with a theoretical and scientific basis, which allowed, considering the professionals' opinion, to verify the care evidences and the practicability of the practices in the study scenario for the construction of a protocol. Care emerged related to puncture, manipulation, salinization and catheter clearance. Conclusion: the protocol construction process involved the participation of all oncology nurses, and all the mentioned care has scientific evidence for its use.

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Effectiveness of heparin versus 0.9% saline solution in maintaining the permeability of central venous catheters: a systematic review

Cited by 20 publications

References 28 publications

Normal saline versus heparin for patency of central venous catheters in adult patients - a systematic review and meta-analysis

Normal saline versus heparin for patency of central venous catheters in adult patients - a systematic review and meta-analysis

Direct cost of maintenance of totally implanted central venous catheter patency

Care Protocol With Totaly Implanted Venous Catheter: A Collective Construction

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