Heparin solution in the prevention of occlusions in Hickman® catheters a randomized clinical trial

Abstract

Objective: to evaluate the effectiveness of the 50 IU/mL heparin solution compared to the 0.9% isotonic saline solution in preventing occlusion of the double lumen Hickman® catheter, 7 and 9 French, in patients undergoing hematopoietic stem cell transplantation. Method: a triple-blind randomized clinical trial. 17 double-lumen catheters (heparin group: n=7 and 0.9% isotonic saline group: n=10) were analyzed in which the two catheter routes were evaluated separately, totaling 34 lumens. The outcome variables were occlusion without reflux and complete occlusion. Descriptive analyses were performed using the Chi-square test and, of survival, according to the Kaplan-Meier test. Results: the mean number of days until the occlusion outcome was 52 in the heparin group and 13.46 in the 0.9% isotonic saline group in the white catheter route (p<0.001). In the red route, the mean follow-up days in the heparin group were 35.29, with no occlusion and 22.30 in the 0.9% isotonic saline group until the first occlusion (p=0.030). Conclusion: blocking with 50 IU/mL heparin solution is more effective than 0.9% isotonic saline in preventing occlusion of the Hickman® catheter. Brazilian Registry of Clinical Trials: RBR-3ht499.

Monitoring of Anticoagulant Activity of Dabigatran and Rivaroxaban in the Presence of Heparins

“…It relies on flushing 5 mL of 0.9% sodium chloride, and discarding 5 mL of blood, or six times that of the catheter dead space volume, before specimen collection. UFH solution is also used to prevent catheter occlusion and infection, but may contaminate the collected blood samples [5,33]. In this and similar situations, it is impossible to correctly assess the anticoagulation of a DOAC alone.…”

“…A problem with measuring DOACs' activity may arise if blood samples also contain heparins, because of the synergistic action of both anticoagulants [4]. Contamination with heparins may occur in patients requiring CVC connection; for example, those with renal failure, cancer, or malnutrition [5,6]. Although concomitant administration of heparin and DOAC is rare in clinical practice, in some situations (e.g., patients on DOAC treatment who receive LMWH before/after surgery or during hemodialysis), LMWHs may remain in the blood and disturb the precise measurement of DOACs' activity [4,[7][8][9][10].…”

The methods for removal of direct oral anticoagulants and heparins to improve the monitoring of hemostasis: a narrative literature review

“…Blood collection from a central venous catheter may yield plasma contamination of heparin, which is used to prevent catheter occlusion and infection [12,57]. As Jeon et al showed that even discarding a higher volume of blood than is recommended cannot avoid heparin contamination while blood collection from catheters [58].…”

“…However, it is not always possible because of the risk of thrombosis [10]. Heparins and DOACs can affect the result of almost every coagulation test, thus precise monitoring of hemostasis in heparinized samples is not possible [10][11][12][13][14][15].…”

Mediport Use As an Acceptable Standard for CAR T Cell Infusion

“…While there are many benefits to mediports, due to the highly personalized and expensive nature of CAR T cell therapy there is a theoretical concern of infiltration. HSCT serves as the paradigmatic example of adoptive cellular transfer, and common pediatric practice is to avoid mediport use for HSCT cell infusions, to ensure more direct systemic stem cell delivery (14,15). Mediport infiltration can occur if the implanted needle dislodges from the port, which could result in the therapy entering the extravascular space.…”