Heparin or 0.9% sodium chloride to maintain central venous catheter patency: A randomized trial
Critical Care Medicine, 06/01/2012
Schallom ME et al. – 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.Methods
- Medical intensive care unit and Surgical/Burn/Trauma intensive care unit at Barnes-Jewish Hospital, St. Louis, MO.
- 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.
- Patients were randomly assigned within 12 hrs of central venous catheter insertion to receive either heparin or 0.9% sodium chloride flush.
- 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.