Document Detail

Heparin flushing and other interventions to maintain patency of central venous catheters: a systematic review.
MedLine Citation:
PMID:  20568318     Owner:  NLM     Status:  MEDLINE    
AIM: This paper is a report of a review to assess clinical studies comparing the effectiveness of different means of maintaining central venous catheter patency.
BACKGROUND: Flushing with heparin is a routine part of central venous catheter maintenance, but it presents risks, including heparin-induced thrombocytopenia. Other techniques used to prevent occlusion of catheters include saline flushes, heparin-bonded catheters and pressure caps.
DATA SOURCES: A search was conducted using the MEDLINE, CINAHL, EMBASE, Cochrane, National Guideline Clearinghouse and University Healthsystem Consortium databases.
METHODS: A systematic review of effectiveness was conducted, using GRADE criteria to assess the strength of evidence for each intervention. The review period covered 1982 or earlier to January 2008.
RESULTS: There is weak evidence that heparin flushing reduces occlusion of catheters, but no evidence that it reduces bloodstream infections. Results from clinical trials of pressure caps are inconsistent regarding their ability to maintain catheter patency, but provide moderate evidence that at least some varieties of caps are associated with increased bloodstream infections.
CONCLUSION: The evidence base on heparin flushing and other interventions to prevent catheter occlusion is small, and published studies are of low quality. There is insufficient evidence on which to conclude that flushing catheters with heparin is more effective than flushing with saline solution.
Matthew D Mitchell; Barbara Jo Anderson; Kendal Williams; Craig A Umscheid
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Journal of advanced nursing     Volume:  65     ISSN:  0309-2402     ISO Abbreviation:  J Adv Nurs     Publication Date:  2009 Oct 
Date Detail:
Created Date:  2010-06-22     Completed Date:  2010-11-26     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7609811     Medline TA:  J Adv Nurs     Country:  England    
Other Details:
Languages:  eng     Pagination:  2007-21     Citation Subset:  IM; N    
Center for Evidence-based Practice, University of Pennsylvania Health System, Philadelphia, USA.
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MeSH Terms
Anticoagulants / administration & dosage*,  adverse effects
Catheter-Related Infections / etiology,  prevention & control*
Catheterization, Central Venous / instrumentation*
Child, Preschool
Equipment Failure
Evidence-Based Practice
Heparin / administration & dosage*,  adverse effects
Infusions, Intra-Arterial* / instrumentation
Nursing Research / methods
Practice Guidelines as Topic
Sodium Chloride / administration & dosage
Thrombocytopenia / chemically induced
Thrombosis / prevention & control
Treatment Outcome
Urokinase-Type Plasminogen Activator / administration & dosage
Reg. No./Substance:
0/Anticoagulants; 7647-14-5/Sodium Chloride; 9005-49-6/Heparin; EC Plasminogen Activator

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

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