Comparing normal saline versus diluted heparin to lock non-valved totally implantable venous access devices in cancer patients: A randomised, non-inferiority, open trial

Annals of Oncology

Volumn 24, Issue 7, 2013, Pages 1892-1899

  Goossens, G A ^a,b   Jerome M ^a   Janssens, C ^a   Peetermans, W E ^a   Fieuws, S ^b,c   Moons, P ^b   Verschakelen, J ^a   Peerlinck, K ^d   Jacquemin, M ^d   Stas, M ^a  

^a UNIVERSITY HOSPITALS LEUVEN   (Belgium)

^b UNIVERSITY OF LEUVEN   (Belgium)

^c HASSELT UNIVERSITY   (Belgium)

^d UNIVERSITY OF LEUVEN   (Belgium)

Author keywords

Catheter lock; Catheter related infection; Equipment failure; Heparin; Sodium chloride

Indexed keywords

HEPARIN; SODIUM CHLORIDE;

ADULT; ARTICLE; BACTEREMIA; BLEEDING; BLOOD CULTURE; BONE CANCER; BREAST CANCER; CANDIDA GLABRATA; CATHETER INFECTION; CENTRAL VENOUS CATHETER; CONTROLLED STUDY; DEVICE REMOVAL; EQUIPMENT FAILURE; FEMALE; FRACTURE; GYNECOLOGIC CANCER; HEAD AND NECK CANCER; HEART ARRHYTHMIA; HEART ATRIUM THROMBOSIS; HEPARIN INDUCED THROMBOCYTOPENIA; HUMAN; INCIDENCE; INTERMETHOD COMPARISON; KIDNEY CANCER; LEUKEMIA; LUNG CANCER; LYMPHOMA; MAJOR CLINICAL STUDY; MALE; MULTIPLE MYELOMA; OUTCOME ASSESSMENT; PLEURA CANCER; PNEUMOTHORAX; PRIORITY JOURNAL; QUALITY CONTROL; RANDOMIZED CONTROLLED TRIAL; RETROSPECTIVE STUDY; RISK FACTOR; SKIN CANCER; SOFT TISSUE CANCER; STAPHYLOCOCCUS AUREUS; STAPHYLOCOCCUS EPIDERMIDIS; STAPHYLOCOCCUS HOMINIS; TOTALLY IMPLANTABLE VENOUS ACCESS DEVICES; UROGENITAL TRACT CANCER; VASCULAR ACCESS; VEIN THROMBOSIS;

CATHETER LOCK; CATHETER-RELATED INFECTION; EQUIPMENT FAILURE; HEPARIN; SODIUM CHLORIDE;

ADOLESCENT; ADULT; AGED; BACTEREMIA; CATHETER-RELATED INFECTIONS; CATHETERIZATION, CENTRAL VENOUS; CATHETERS, INDWELLING; FEMALE; HEPARIN; HUMANS; KAPLAN-MEIER ESTIMATE; MALE; MIDDLE AGED; NEOPLASMS; SODIUM CHLORIDE; SOLUTIONS; YOUNG ADULT;

EID: 84883769702     PISSN: 09237534     EISSN: 15698041     Source Type: Journal    
DOI: 10.1093/annonc/mdt114     Document Type: Article

References (30)

1. Goode CJ, Titler M, Rakel B et al. A meta-analysis of effects of heparin flush and saline flush: quality and cost implications. Nurs Res 1991; 40: 324-330.
2. Del Cotillo M, Grane N, Llavore M et al. Heparinized solution vs. saline solution in the maintenance of arterial catheters: a double blind randomized clinical trial. Intensive Care Med 2008; 34: 339-343.
3. Stephens LC, Haire WD, Tarantolo S et al. Normal saline versus heparin flush for maintaining central venous catheter patency during apheresis collection of peripheral blood stem cells (PBSC). Transfus Sci 1997; 18: 187-193.
4. Mitchell MD, Anderson BJ, Williams K et al. Heparin flushing and other interventions to maintain patency of central venous catheters: a systematic review. J Adv Nurs 2009; 65: 2007-2021
5. Capdevila JA, Gavalda J, Fortea J et al. Lack of antimicrobial activity of sodium heparin for treating experimental catheter-related infection due to Staphylococcus aureus using the antibiotic-lock technique. Clin Microbiol Infect 2001; 7: 206-212.
6. Shanks RM, Donegan NP, Graber ML et al. Heparin stimulates Staphylococcus aureus biofilm formation. Infect Immun 2005; 73: 4596-4606.
7. Muslimani AA, Ricaurte B, Daw HA. Immune heparin-induced thrombocytopenia resulting from preceding exposure to heparin catheter flushes. Am J Hematol 2007; 82: 652-655.
8. Bates DW. Unexpected hypoglycemia in a critically ill patient. Ann Intern Med 2002; 137: 110-116.
9. Liu D, Zhang LP, Huang SF et al. Outbreak of Serratia marcescens infection due to contamination of multiple-dose vial of heparin-saline solution used to flush deep venous catheters or peripheral trocars. J Hosp Infect 2011; 77: 175-176.
10. Goossens GA, Verbeeck G, Moons P et al. Functional evaluation of conventional 'Celsite' venous ports versus 'Vortex' ports with a tangential outlet: a prospective randomised pilot study. Support Care Cancer 2008; 16: 1367-1374.
11. Stas M, Mulier S, Pattyn P et al. Peroperative intravasal electrographic control of catheter tip position in access ports placed by venous cut-down technique. Eur J Surg Oncol 2001; 27: 316-320.
12. Goossens GA, Stas M, Jérôme M et al. Systematic review: malfunction of totally implantable venous access devices in cancer patients. Support Care Cancer 2011; 19: 883-898.
13. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008; 36: 309-332.
14. Caers J, Fontaine C, Vinh-Hung V et al. Catheter tip position as a risk factor for thrombosis associated with the use of subcutaneous infusion ports. Support Care Cancer 2005; 13: 325-331.
15. Spiegelman D, Hertzmark E. Easy SAS calculations for risk or prevalence ratios and differences. Am J Epidemiol 2005; 162: 199-200.
16. Bishop L, Dougherty L, Bodenham A et al. Guidelines on the insertion and management of central venous access devices in adults. Int J Lab Hematol 2007; 29: 261-278.
17. Registered Nurses' Association of Ontario. Care and Maintenance to Reduce Vascular Access Complications. Toronto, Canada: Registered Nurses' Association of Ontario, 2005.
18. RCN IV Therapy Forum. Standards for Infusion Nursing. London: Royal College of Nursing, 2010.
19. Pratt RJ, Pellowe CM, Wilson JA et al. epic2: national evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England. J Hosp Infect 2007; 65: S1-S64.
20. Theard JL, Robard S. Outcome of usage protocols on implantable devices. Ann Fr Anesth Reanim 1995; 14: 534-535.
21. Goossens GA, Stas M, Moons P. Management of functional complications of totally implantable venous access devices by an advanced practice nursing team: 5 years of clinical experience. Eur J Oncol Nurs 2012; 16: 465-471.
22. Guiffant G, Durussel JJ, Merckx J et al. Flushing of intravascular access devices (IVADs)-efficacy of pulsed and continuous infusions. J Vasc Access 2012; 13: 75-78.
23. Heibl C, Trommet V, Burgstaller S et al. Complications associated with the use of Port-a-Caths in patients with malignant or haematological disease: a single-centre prospective analysis. Eur J Cancer Care (Engl) 2010; 19: 676-681.
24. Beckers MM, Ruven HJ, Seldenrijk CA et al. Risk of thrombosis and infections of central venous catheters and totally implanted access ports in patients treated for cancer. Thromb Res 2010; 125: 318-321.
25. Chang YF, Lo AC, Tsai CH et al. Higher complication risk of totally implantable venous access port systems in patients with advanced cancer-a single institution retrospective analysis. Palliat Med 2013; 27: 185-191.
26. Bertoglio S, Solari N, Meszaros P et al. Efficacy of normal saline versus heparinized saline solution for locking catheters of totally implantable long-term central vascular access devices in adult cancer patients. Cancer Nurs 2012; 35: E35-E42.
27. Gastmeier P, Geffers C. Prevention of catheter-related bloodstream infections: analysis of studies published between 2002 and 2005. J Hosp Infect 2006; 64: 326-335.
28. O'Grady NP, Alexander M, Burns LA et al. Summary of recommendations: guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis 2011; 52: 1087-1099.
29. Head SJ, Kaul S, Bogers AJ et al. Non-inferiority study design: lessons to be learned from cardiovascular trials. Eur Heart J 2012; 33: 1318-1324.
30. Lapalu J, Losser MR, Albert O et al. Totally implantable port management: impact of positive pressure during needle withdrawal on catheter tip occlusion (an experimental study). J Vasc Access 2010; 11: 46-51.