Flushing the central venous catheter: Is heparin necessary?

Journal of Vascular Access

Volumn 15, Issue 4, 2014, Pages 241-248

  Dal Molin, Alberto ^a   Allara, Elias ^a   Montani, Doriana ^a   Milani, Simona ^b   Frassati, Cristina ^b   Cossu, Simonetta ^b   Tonella, Simone ^b   Brioschi, Dania ^b   Rasero, Laura ^c  

^a UNIVERSITY OF EASTERN PIEDMONT   (Italy)

^b Biella Hospital   (Italy)

^c UNIVERSITY OF FLORENCE   (Italy)

Author keywords

Central venous catheter; Flushing; Heparin; Saline

Indexed keywords

ASCORBIC ACID; HEPARIN; LEPIRUDIN; SODIUM CHLORIDE; UROKINASE; ANTICOAGULANT AGENT;

BAYES THEOREM; CATHETER INFECTION; CATHETER OCCLUSION; CATHETERIZATION; CENTRAL VENOUS CATHETER; COMPARATIVE EFFECTIVENESS; FLUSHING; HEPARIN INDUCED THROMBOCYTOPENIA; HUMAN; META ANALYSIS; RANDOMIZED CONTROLLED TRIAL (TOPIC); REVIEW; VASCULAR PATENCY; VENOUS THROMBOEMBOLISM; ADVERSE EFFECTS; CATHETER OBSTRUCTION; CENTRAL VENOUS CATHETERIZATION; DEVICES; INDWELLING CATHETER; LAVAGE; PROCEDURES; RISK FACTOR; TREATMENT OUTCOME; UPPER EXTREMITY DEEP VEIN THROMBOSIS;

ANTICOAGULANTS; CATHETER OBSTRUCTION; CATHETERIZATION, CENTRAL VENOUS; CATHETERS, INDWELLING; CENTRAL VENOUS CATHETERS; HEPARIN; HUMANS; RISK FACTORS; THERAPEUTIC IRRIGATION; TREATMENT OUTCOME; UPPER EXTREMITY DEEP VEIN THROMBOSIS;

EID: 84905269175     PISSN: 11297298     EISSN: None     Source Type: Journal    
DOI: 10.5301/jva.5000225     Document Type: Review

References (39)

1. Gillanders L, Angstmann K, Ball P, et al; Australasian Society of Parenteral and Enteral Nutrition. AuSPEN clinical practice guideline for home parenteral nutrition patients in Australia and New Zealand. Nutrition. 2008;24(10):998-1012.
2. INS Standards-Intravenous Nurses Society. Infusion nursing standard of practice. Journal of Intravenous Nursing. 2011;34(1S):S96.
3. Gallieni M, Pittiruti M, Biffi R. Vascular access in oncology patients. CA Cancer J Clin. 2008;58(6):323-346.
4. Vescia S, Baumgärtner AK, Jacobs VR, et al. Management of venous port systems in oncology: a review of current evidence. Ann Oncol. 2008;19(1):9-15.
5. Kuo YS, Schwartz B, Santiago J, Anderson PS, Fields AL, Goldberg GL. How often should a port-A-cath be flushed? Cancer Invest. 2005;23(7):582-585.
6. Dal Molin A, Rasero L, Guerretta L, Perfetti E, Clerico M. The late complications of totally implantable central venous access ports: the results from an Italian multicenter prospective observation study. Eur J Oncol Nurs. 2011;15(5): 377-381.
7. Kefeli U, Dane F, Yumuk PF, et al. Prolonged interval in prophylactic heparin flushing for maintenance of subcutaneous implanted port care in patients with cancer. Eur J Cancer Care (Engl). 2009;18(2):191-194.
8. Ignatov A, Ignatov T, Taran A, Smith B, Costa SD, Bischoff J. Interval between port catheter flushing can be extended to four months. Gynecol Obstet Invest. 2010;70(2):91-94.
9. RCN Standards-Royal College of Nurses. Standards for infusion therapy, 2010.
10. 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(Suppl 1):S1-S64.
11. Clemence MA, Walker D, Farr BM. Central venous catheter practices: results of a survey. Am J Infect Control. 1995;23(1):5-12.
12. Sona C, Prentice D, Schallom L. National survey of central venous catheter flushing in the intensive care unit. Crit Care Nurs. 2012;32(1):e12-e19.
13. Passannante A, Macik BG. The heparin flush syndrome: a cause of iatrogenic hemorrhage. Am J Med Sci. 1988;296(1):71-73.
14. Garajová I, Nepoti G, Paragona M, Brandi G, Biasco G. Port-a-Cath-related complications in 252 patients with solid tissue tumours and the first report of heparin-induced delayed hypersensitivity after Port-a-Cath heparinisation.Eur J Cancer Care (Engl). 2013;22(1):125-132.
15. Milani A. Positive pressure and normal saline instead of heparinized solution when washing indwelling ports in patients with cancer. Presented at the 2005 ECCO Congress, Paris.
16. Da Ros L, Ponzo C, Storto S, Ciuffreda L. Assessment of the use of heparinated solution for clamping medium/ long term CVC after 8 hours. Ann Oncol. 2008;19(Supp 9): x112-ix117.
17. Schallom ME, Prentice D, Sona C, Micek ST, Skrupky LP. Heparin or 0.9% sodium chloride to maintain central venous catheter patency: a randomized trial. Crit Care Med. 2012;40(6):1820-1826.
18. Randolph AG, Cook DJ, Gonzales CA, Andrew M. Benefit of heparin in peripheral venous and arterial catheters: systematic review and meta-analysis of randomised controlled trials. BMJ. 1998;28(316):969-975.
19. 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(6):324-330.
20. Peterson FY, Kirchhoff KT. Analysis of the research about heparinized versus nonheparinized intravascular lines. Heart Lung. 1991;20(6):631-640.
21. Richardson WS, Wilson MC, Nishikawa J, Hayward RS. The well-built clinical question: a key to evidence-based decisions. ACP J Club. 1995;123(3):A12-A13.
22. Altman DG. Practical Statistics for Medical Research. London: Chapman & Hall; 1992.
23. Guyatt GH, Sackett DL, Cook DJ. Users' guides to the medical literature. II. How to use an article about therapy or prevention. JAMA. 1993;270:2598-2601 and 1994;271(1):59-63.
24. Chaimani A, Salanti G. Background document. Proceedings on the "Statistical issues in NMA" CMIMG Meeting. 2013. Available from: http://cmimg.cochrane.org/sites/cmimg.cochrane.org/files/uploads/CMIMG%20Stream%202%20document%202013%2010%2001.pdf. Accessed 30 January, 2014.
25. Higgins JPT, Jackson D, Barrett JK, Lu G, Ades AE, White IT. Consistency and inconsistency in network meta-analysis: concepts and models for multi-arm studies. Res Synth Methods 2012:3(2):98-110.
26. Mills EJ, Thorlund K, Ioannidis JPA. Demystifying trial networks and network meta-analysis. BMJ. 2013;346(May14): f2914.
27. White I. Multivariate random-effects meta-analysis. Stata J. 2009;9:40-56.
28. i Pumarola CF, Mercader RC, Plana MC, et al. Comparative study of maintenance of patency of triple-lumen central venous catheter. Enferm Intensiva. 2007;1(18):25-35.
29. Bowers L, Speroni KG, Jones L, Atherton M. Comparison of occlusion rates by flushing solutions for peripherally inserted central catheters with positive pressure Luer-activated devices. J Infus Nurs. 2008;31(1):22-27.
30. Goossens GA, Jérôme M, Janssens C, et al. Comparing normal saline versus diluted heparin to lock non-valved totally implantable venous access devices in cancer patients: a randomised, non-inferiority, open trial. Ann Oncol. 2013;24(7):1892-1899.
31. Ray CE Jr, Shenoy SS, McCarthy PL, Broderick KA, Kaufman JA. Weekly prophylactic urokinase instillation in tunneled central venous access devices. J Vasc Interv Radiol. 1999;10(10):1330-1334.
32. Solomon B, Moore J, Arthur C, Prince HM. Lack of efficacy of twice-weekly urokinase in the prevention of complications associated with Hickman catheters: a multicentre randomised comparison of urokinase versus heparin. Eur JCancer. 2001;37(18):2379-2384.
33. Horne MK III, McCloskey DJ, Calis K, Wesley R, Childs R, Kasten-Sportes C. Use of heparin versus lepirudin flushes to prevent withdrawal occlusion of central venous access devices. Pharmacotherapy. 2006;26(9):1262-1267.
34. Rabe C, Gramann T, Sons X, et al. Keeping central venous lines open: a prospective comparison of heparin, vitamin C and sodium chloride sealing solutions in medical patients. Intensive Care Med. 2002;28(8):1172-1176.
35. Dal Molin A, Di Massimo DS, Braggion C, et al. Totally implantable central venous access ports in patients with cystic fibrosis: a multicenter prospective cohort study. J Vasc Access. 2012;13(3):290-295.
36. Registered Nurses Association of Ontario (RNAO). Care and maintenance to reduce vascular access complication. Nursing Best Practice Guideline. 2008.
37. Mitchell MD, Anderson BJ, Williams K, Umscheid CA. Heparin flushing and other interventions to maintain patency of central venous catheters: a systematic review. J Adv Nurs. 2009;65(10):2007-2021.
38. López-Briz E, Ruiz-García V. [Effectiveness of heparin versus NaCl 0.9% in central venous catheter flushing. A systematic review]. Farm Hosp. 2005;29(4):258-264.
39. 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(4):E35-E42.