Heparinized and Saline Solutions in the Maintenance of Arterial and Central Venous Catheters After Cardiac Surgery

Ziyaeifard, Mohsen; Alizadehasl, Azin; Aghdaii, Nahid; Sadeghi, Ali; Azarfarin, Rasoul; Masoumi, Gholamreza; Golbargian, Ghodrat

doi:10.5812/aapm28056

Cited by 23 publications

(28 citation statements)

References 13 publications

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“…Thus, a total of 10 studies were eligible according to the inclusion criteria. The 10 studies were from Germany [13] ( n = 1), Spain [6] ( n = 1), Belgium [26] ( n = 1), Italy [27] ( n = 1), Japan [28] ( n = 1), Iran [29, 30] ( n = 2) and the USA [2, 31, 32] ( n = 3). As a result, the 10 trials, including four ICU and six non-ICU studies, were reported in the years 2002–2015 and the average duration of follow up ranged from 1 to 400 days.…”

Section: Resultsmentioning

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: Resultsmentioning

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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“…Prior to the COVID-19 outbreak, a number of studies have examined the use of LDHS protocols in ICU patients to improve a-line patency, with mixed results [ [6] , [7] , [8] , [9] , [10] , [11] , [12] , 25 , 26 ]. The proposed mechanism of the LDHS protocol is infusing the anticoagulant directly to the site of potential clot formation proximal to the catheter tip.…”

Section: Discussionmentioning

confidence: 99%

“…Outcomes are mixed on the success of similar LDHS protocols implemented to improve a-line duration in non-COVID-19 patients. While some randomized-controlled trials report improved a-line patency in medical ICU and pediatric patients [ [6] , [7] , [8] ], several studies found no clinical effect [ [9] , [10] , [11] , [12] ], and these protocols have not been widely implemented. Study populations and dosages varied between studies, and thus it was unclear whether an LDHS protocol would benefit critically ill patients with COVID-19.…”

Section: Introductionmentioning

confidence: 99%

A low dose heparinized saline protocol is associated with improved duration of arterial line patency in critically ill COVID-19 patients

Maurer

Luckhurst

Hamidi

et al. 2020

Journal of Critical Care

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Purpose Critically ill patients with Coronavirus Disease 2019 (COVID-19) have high rates of line thrombosis. Our objective was to examine the safety and efficacy of a low dose heparinized saline (LDHS) arterial line (a-line) patency protocol in this population. Materials and Methods In this observational cohort study, patients ≥18 years with COVID-19 admitted to an ICU at one institution from March 20–May 25, 2020 were divided into two cohorts. Pre-LDHS patients had an episode of a-line thrombosis between March 20–April 19. Post-LDHS patients had an episode of a-line thrombosis between April 20–May 25 and received an LDHS solution (10 units/h) through their a-line pressure bag. Results Forty-one patients (pre-LDHS) and 30 patients (post-LDHS) were identified. Baseline characteristics were similar between groups, including age (61 versus 54 years; p = 0.24), median Sequential Organ Failure Assessment score (6 versus 7; p = 0.67) and systemic anticoagulation (47% versus 32%; p = 0.32). Median duration of a-line patency was significantly longer in post-LDHS versus pre-LDHS patients (8.5 versus 2.9 days; p < 0.001). The incidence of bleeding complications was similar between cohorts (13% vs. 10%; p = 0.71). Conclusions A LDHS protocol was associated with a clinically significant improvement in a-line patency duration in COVID-19 patients, without increased bleeding risk.

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“…Despite the overwhelming evidence in human patients showing that 0.9% sodium chloride is an effective flushing solution to maintain CVC patency (Bradford et al 2015;Bradford et al 2016a;Bradford et al 2016b;Heidari Gorji et al 2015;LeDuc 1997;Ziyaeifard et al 2015), heparinized saline is still used in many veterinary facilities (Fleeman 2001). Based on the results of the present study, 0.9% sodium chloride appears to be a safe alternative to heparin for flushing CVCs and may prove to be more cost effective for facilities, saving both time and money (Ridyard et al 2017).…”

Section: Discussionmentioning

confidence: 99%

Peer Review #1 of "Comparison of heparinized saline and 0.9% sodium chloride for maintaining central venous catheter patency in healthy dogs (v0.1)"

Holowaychuk¹

2019

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Background. The purpose of this study was to determine whether heparinized saline would be more effective in maintaining the patency of central venous catheters (CVC) in dogs compared to 0.9% sodium chloride. This was a prospective randomized blinded study conducted at the University Veterinary Teaching Hospital. Methods. Twenty-four healthy purpose bred dogs were randomized into two groups: a treatment and a control group. A CVC was placed in the jugular vein of each dog. Each dog in the treatment group had their CVC flushed with 10 IU/mL heparinized saline, while dogs in the control group had their CVC flushed with 0.9% sodium chloride every 6 hours for 72 hours. Immediately prior to flushing, each catheter was evaluated for patency by aspiration of blood. The catheter site was also evaluated for phlebitis, and a rectal temperature was obtained in each dog every six hours. Prothrombin (PT) and activated partial thromboplastin (aPTT) times were evaluated prior to the administration of any flush solution. Results were then compared to values obtained 72 hours later. Results. All CVCs in both groups were patent after 72 hours, which was demonstrated by aspiration of blood and ease of flushing the catheter. Two CVCs in the 0.9% sodium chloride group had a negative aspiration at hour 12 and 36, respectively. One CVC in the heparinized saline group had a negative aspiration at hour 18. Signs of phlebitis occurred in three dog: two in the 0.9% sodium chloride group and one in the heparinized saline group. No dog was hyperthermic (>103°F). Two catheters were inadvertently removed by dogs in the heparinized saline group during the study. There were no significant differences in catheter patency, incidence of phlebitis, or incidence of negative aspirations between both groups. aPTT and PT values remained within the normal reference range for all dogs in both groups. Ultimately, 0.9% sodium chloride was as effective as 10 IU/mL heparinized saline in maintaining the patency of

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Heparinized and Saline Solutions in the Maintenance of Arterial and Central Venous Catheters After Cardiac Surgery

Cited by 23 publications

References 13 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

A low dose heparinized saline protocol is associated with improved duration of arterial line patency in critically ill COVID-19 patients

Peer Review #1 of "Comparison of heparinized saline and 0.9% sodium chloride for maintaining central venous catheter patency in healthy dogs (v0.1)"

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