Pilot Randomized Trial of a Three Times Weekly Heparin Flushing Intervention in Children, Adolescents, and Young Adults With Cancer With Tunneled Central Venous Catheters

Abstract

Background: Children and adolescents with cancer often undergo aggressive treatment and receive supportive care requiring a long-term tunneled central venous catheter (TCVC). Regular flushing promotes TCVC patency when not in use (i.e., noninfusing). However, TCVC flushing guidelines and the current practice of daily flushing are not based on high-quality evidence. Few studies have compared the effect of less frequent flushing on TCVC patency. The purpose of this study was to evaluate the feasibility of a three times weekly heparin flushing intervention, as compared to daily heparin flushing, in children and adolescents and young adults (AYAs) with noninfusing TCVCs. Methods: Twenty children and AYAs were randomized to one of two groups, standard of care (SOC) (i.e., daily heparin flushing) or intervention (three times weekly heparin flushing) for 8 weeks. Feasibility data (recruitment, retention, acceptability, TCVC patency, and complications) were analyzed descriptively. Results: Twenty of 22 eligible patients were enrolled in the study (90% recruitment rate). Four participants discontinued the study early due to TCVC removal (20% attrition rate). One participant in each group had their TCVC removed due to a central line-associated bloodstream infection, one SOC group participant had their TCVC removed due to damage, and one intervention group participant had their TCVC removed due to discontinuation of treatment. No participants were withdrawn for safety concerns or because they did not find the protocol acceptable. Conclusions: It is feasible to conduct a large-scale randomized controlled trial to investigate a three times weekly heparin flushing intervention in children and AYAs with TCVCs.

Unfractionated heparin: optimizing laboratory monitoring and reducing unwanted interference in everyday hemostasis test practice

“…There are advantages and limitations to either approach. 3,9 - 13 The anti Xa method is considered superior and more advantageous than the APTT for several reasons (TAbLE 2). First, it is a more di rect method of assessing UFH activity, and does not require establishing a TRR.…”

“…The anti Xa method is also less susceptible to assay interference, as, in contrast to APTT, it is not influenced by the presence of lupus anti coagulant (LA), factor (F) deficiency (especially catheter patency, and preventing clot formation and / or blockage within a variety of arterial and venous catheters. [13][14][15] Here, UFH may be used to fill a catheter or flush it between uses. UFH is also commonly used as an anticoagulant during renal dialysis 16 or ECMO treatment, 17,18 that is, a form of life support for people with life threatening ill nesses or injuries that affect functioning of their heart or lungs.…”