Document Detail


Heparin or 0.9% sodium chloride to maintain central venous catheter patency: a randomized trial.
MedLine Citation:
PMID:  22488006     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To compare heparin (3 mL, 10 units/mL) and 0.9% sodium chloride (NaCl, 10 mL) flush solutions with respect to central venous catheter lumen patency.
DESIGN: Single-center, randomized, open label trial.
SETTING: Medical intensive care unit and Surgical/Burn/Trauma intensive care unit at Barnes-Jewish Hospital, St. Louis, MO.
PATIENTS: Three hundred forty-one patients with multilumen central venous catheters. Patients with at least one lumen with a minimum of two flushes were included in the analysis.
INTERVENTIONS: Patients were randomly assigned within 12 hrs of central venous catheter insertion to receive either heparin or 0.9% sodium chloride flush.
MEASUREMENTS AND MAIN RESULTS: The primary outcome was lumen nonpatency. Secondary outcomes included the rates of loss of blood return, inability to infuse or flush through the lumen (flush failure), heparin-induced thrombocytopenia, and catheter-related blood stream infection. Assessment for patency was performed every 8 hrs in lumens without continuous infusions for the duration of catheter placement or discharge from intensive care unit. Three hundred twenty-six central venous catheters were studied yielding 709 lumens for analysis. The nonpatency rate was 3.8% in the heparin group (n = 314) and 6.3% in the 0.9% sodium chloride group (n = 395) (relative risk 1.66, 95% confidence interval 0.86-3.22, p = .136). The Kaplan-Meier analysis for time to first patency loss was not significantly different (log rank = 0.093) between groups. The rates of loss of blood return and flush failure were similar between the heparin and 0.9% sodium chloride groups. Pressure-injectable central venous catheters had significantly greater rates of nonpatency (10.6% vs. 4.3%, p = .001) and loss of blood return (37.0% vs. 18.8%, p <.001) compared to nonpressure-injectable catheters. The frequencies of heparin-induced thrombocytopenia and catheter-related blood stream infection were similar between groups.
CONCLUSION: 0.9% sodium chloride and heparin flushing solutions have similar rates of lumen nonpatency. Given potential safety concerns with the use of heparin, 0.9% sodium chloride may be the preferred flushing solution for short-term use central venous catheter maintenance.
Authors:
Marilyn E Schallom; Donna Prentice; Carrie Sona; Scott T Micek; Lee P Skrupky
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Critical care medicine     Volume:  40     ISSN:  1530-0293     ISO Abbreviation:  Crit. Care Med.     Publication Date:  2012 Jun 
Date Detail:
Created Date:  2012-05-21     Completed Date:  2012-07-13     Revised Date:  2012-12-14    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1820-6     Citation Subset:  AIM; IM    
Affiliation:
Department of Nursing, Barnes-Jewish Hospital at Washington University, St. Louis, MO, USA. mes4143@bjc.org
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Anticoagulants / administration & dosage*
Catheterization, Central Venous / methods*
Female
Heparin / administration & dosage*
Humans
Intensive Care Units
Male
Middle Aged
Sodium Chloride / administration & dosage*,  chemistry
Vascular Patency*
Chemical
Reg. No./Substance:
0/Anticoagulants; 7647-14-5/Sodium Chloride; 9005-49-6/Heparin
Comments/Corrections
Comment In:
Crit Care Med. 2012 Nov;40(11):3108; author reply 3108-9   [PMID:  23080458 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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