| Heparin or 0.9% sodium chloride to maintain central venous catheter patency: a randomized trial. | |
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MedLine Citation:
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PMID: 22488006 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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Marilyn E Schallom; Donna Prentice; Carrie Sona; Scott T Micek; Lee P Skrupky |
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Publication Detail:
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Type: Journal Article; Randomized Controlled Trial |
Journal Detail:
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Title: Critical care medicine Volume: 40 ISSN: 1530-0293 ISO Abbreviation: Crit. Care Med. Publication Date: 2012 Jun |
Date Detail:
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Created Date: 2012-05-21 Completed Date: 2012-07-13 Revised Date: 2012-12-14 |
Medline Journal Info:
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Nlm Unique ID: 0355501 Medline TA: Crit Care Med Country: United States |
Other Details:
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Languages: eng Pagination: 1820-6 Citation Subset: AIM; IM |
Affiliation:
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Department of Nursing, Barnes-Jewish Hospital at Washington University, St. Louis, MO, USA. mes4143@bjc.org |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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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:
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0/Anticoagulants; 7647-14-5/Sodium Chloride; 9005-49-6/Heparin |
| Comments/Corrections | |
Comment In:
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Crit Care Med. 2012 Nov;40(11):3108; author reply 3108-9
[PMID:
23080458
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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