Keeping central venous lines open: a prospective comparison of heparin, vitamin C and sodium chloride sealing solutions in medical patients

Abstract

Local anticoagulation of intermittently used central venous catheters prolongs catheter patency. High-dose (5000 IU/ml) heparin solution is a useful anticoagulant for this purpose, while vitamin C solution does not prolong catheter patency.

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) .…”

“…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) . Despite the potential benefits of saline solution, the change in clinical practice for a normal saline solution has not been widely suggested in the literature for the whole typology of patients and CVC.…”

“…citrate). Although most of the study's corpus suggest the use of saline solution, one study (6) concluded that heparinized solutions are more effective when compared to saline solution for maintaining CVC patency. It is important to note that the flush technique has not been described in detail and it was performed only every 48 hours, which may have contributed to the differences, for example, in comparing this procedure to the study (11) in which the flush technique has been described in detail and implemented every 8 hours.…”

“…For these reasons, CVC handling, maintenance and optimization is complicit to the predominant value of care, where nurses must gather a body of knowledge and skills to ensure proper handling of the CVC (5) . Nevertheless, despite the existence of several international recommendations and guidelines related to this subject, doubts still persist regarding which should be used when we discuss the recommended solution to maintaining CVC patency, since there are several practices in use in the clinical setting (saline, heparin, sodium citrate, and other chemical solutions) (6) . Historically, heparin solution has been the most commonly used method to maintain catheter patency, dating back to the 1970s (1) .…”

Preventing Catheter-Related Bacteremia with Taurolidine-Citrate Catheter Locks: A Systematic Review and Meta-Analysis

“…A number of strategies to reduce the incidence of CRB have been tried, including the use of strict hygienic measures, antibiotic-impregnated catheters, eradication of Staphylococcus aureus nasal carriage and prophylactic antibiotic ointment on the exit site [7]. Taurolidine and heparin, which can reduce the incidence of CRB, are often used as a solution to prevent bacteremia in patients who need a central catheter, as with hemodialysis, cancer and parenteral nutrition, as well as in the ICU [8,9,10,11]. It has been suggested that heparin, the most common catheter lock in clinical practice, may be abandoned because spilling into the bloodstream may expose patients to the risk of bleeding [12].…”