Efficacy of Normal Saline Versus Heparinized Saline Solution for Locking Catheters of Totally Implantable Long-Term Central Vascular Access Devices in Adult Cancer Patients

Abstract

Switching from heparinized solution to normal saline for catheter intermittent lock of ports seems a safe procedure.

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

“…Bibliography analysis of identified reference articles also allowed the inclusion of another study, thus nine studies were considered for critical appraisal: eight RCT (2,6,9,(11)(12)(13)(14)16) and one cohort study (10) .…”

“…Heparin by itself is not a thrombolytic agent, it does not cause lysis or clot "fragmentation," but prevents the progression of previously existing clots by inhibiting the factors related to the process of clot formation, allowing lysis of the naturally occurring clot. Moreover, heparin has a very short lifespan (60 to 90 min) and no data or evidence present perfect validity of the dilution and therapeutic components of CVC to meet the therapeutic effect on one hand, and on the other and even more critically do not produce its undesirable side effects (10) . Moreover, there is no evidence in the literature that the concentration of heparin alone is related to improved permeable CVC rates, assuming a balance between effectiveness and safety of the patient (10) .…”

“…Moreover, heparin has a very short lifespan (60 to 90 min) and no data or evidence present perfect validity of the dilution and therapeutic components of CVC to meet the therapeutic effect on one hand, and on the other and even more critically do not produce its undesirable side effects (10) . Moreover, there is no evidence in the literature that the concentration of heparin alone is related to improved permeable CVC rates, assuming a balance between effectiveness and safety of the patient (10) . However, the systemic effects of the use of heparin and the development of heparin-induced thrombocytopenia may constitute a problem (6) .…”

“…We cannot help but reflect on the different focuses that are necessary in this practice of nursing: thrombocytopenia is related to the frequent use of heparin; thrombocytopenia risk exists even when the exposure is minimal; heparin is found in various concentrations and formulations, increasing the risk of error in dilution preparation; and several studies have suggested that heparin is related to medication errors (1,3) . On the other hand, some studies suggest that saline flush is cost-effective, adequate and also has the benefit of not having the adverse effects of heparin and not having several presentations nor preparation required at different concentrations (2,(9)(10)(11)(12)(13)(14) . In this context, some published studies have reported that most nurses use only saline solutions, enhancing the fact that CVC flushing practices vary widely, and are currently inconsistent (15) .…”

Central Nervous System Hemorrhage Following Lumbar Puncture for Intrathecal Chemotherapy in a Pediatric Oncology Patient

“…There is no information from the medical record as to how the port was used intraoperatively, as to when the last time the port had been flushed, and whether the port was aspirated prior to the infusion of intravenous fluids. Although common practice in most institutions, it is unknown what impact these practices have on coagulation function especially in patients with concomitant thrombocytopenia or platelet dysfunction [21,22]. Lower doses of heparin and normal saline solution may be as effective with less impact on coagulation function [21,22].…”