Maintenance of the Patency of Indwelling Central Venous Catheters

A review of 560 Hickman catheter insertions

“…In our series 0.38 per 1000 catheters required removal because of occlusion and similar rates have been reported whether or not routine catheter flushing is performed [35]. Alternative to heparinised saline for flushing are saline 0.9'% [36] and disodium EDTA. (20 mF.nil ' ) [37].…”

Heparin versus 0.9% sodium chloride intermittent flushing for the prevention of occlusion in long term central venous catheters in infants and children: A systematic review

“…We contacted three individual study authors for further study details and were able to find further information for two studies (Goossens et al, 2013, Smith et al, 1991. Of the 10 studies, three met the inclusion criteria (Cesaro et al, 2009, Goossens et al, 2013, Smith et al, 1991 and were included in this review. Details of data extraction are summarised in Table 1.…”

“…All participants had a long-term central venous catheter placed, and were undergoing treatment for haematology or oncology conditions. Participants in Cesaro et al, (2009) andSmith et al, (1991) had Broviac tunnelled CVCs inserted, whereas all participants in Goossens et al, (2013) had totally inserted catheters (ports) placed. All studies were undertaken in developed nations in tertiary referral centres.…”

“…All studies involved an experimental arm where normal saline solution was used in place of standard solution (heparinised saline) when the CVC was not being used. As well as changing the type of solution used to flush the CVC, Smith et al, (1991) increased the time between flushes in the intervention arm from twice daily to weekly. Similarly, Cesaro et al, (2009) increased the duration between flushes in the intervention arm compared to standard care from twice per week to weekly.…”

Thrombolytic therapy for central venous catheter occlusion

“…52 However, a prospective study that evaluated twice weekly heparin flushes versus weekly saline flushes in 203 children with Broviac-Hickman CVCs demonstrated an increased rate of catheter occlusions (83% vs. 41%, P=0.0002) and catheter infections (65% vs. 44%, P=0.01) with saline flushes. 53 Although most guidelines for subcutaneous ports recommend monthly flushes when not in use, two studies have demonstrated that increased periods of time between flushes, from six weeks to three months, may not increase the frequency of complications.…”