Heparin-induced thrombocytopenia--recognition and treatment

Heparinized saline versus normal saline for maintaining peripheral venous catheter patency in China: An open-label, randomized controlled study

Objective

To evaluate the effects of heparin saline versus normal saline as locking solution for maintaining patency in peripheral venous catheters in Chinese patients.

Methods

This open-label, randomized controlled study was conducted in two hepatobiliary surgery wards, where patients received identical treatments, at a tertiary referral hospital. Patients were randomly divided into a normal saline group (NS, 3 ml) or a heparin saline group (HS, 50 IU/ml, 3 ml) for catheter sealing.

Results

The study enrolled 286 patients and 609 peripheral venous catheters were included in the analysis. The patients in the two groups had no local infections or catheter-related bloodstream infections. There were no significant differences between the two groups in terms of the rate of catheter obstruction, duration time, or the rates of phlebitis, infiltration, and accidental catheter removal.

Conclusions

No significant differences in the peripheral venous catheter sealing effects were observed between normal saline and heparin saline usage in Chinese patients.

Management of central venous catheters in pediatric onco-hematology using 0.9% sodium chloride and positive-pressure-valve needleless connector

PURPOSE

To describe, in a sample of pediatric onco-hematological patients, the rate of occlusions in unused central venous catheters (CVC) flushed once a week with a 0.9% sodium chloride solution through a positive-pressure-valve needleless connector.

METHOD

Retrospective cohort study. Subjects aged 0-17 years were identified through a manual search in medical and nursing records and were observed for two years or until the occurrence of one of the following events: start or resume of continuous infusion; CVC removal; death. The primary study outcome was the frequency of CVC occlusion (partial or complete).

RESULTS

Fifty-one patients were identified (median age 6 years). The median duration of follow-up was 169 days (IQR 111-305). During the follow up period, 14 patients (27%) had one CVC occlusion, in 2 cases (4%) the occlusion was complete, in 12 (23%) partial. All the occlusions were solved without the need for catheter removal. The lumen diameter ≤ 4.2 vs > 4.2 French showed a statistically significant association with occlusion at multivariate analysis (OR 4.0; 95% CI 1.1-14.7).

CONCLUSIONS

Our findings are reassuring with respect to the management of the CVC using the adopted protocol. The study provides useful information for patient care, by verifying the performance of the adopted CVC management protocol and by identifying critical areas for nursing care.

Comparison of occlusion rates by flushing solutions for peripherally inserted central catheters with positive pressure Luer-activated devices

In this prospective, randomized study of 102 subjects with single-lumen peripherally inserted central catheters with positive pressure Luer-activated devices, 2 flushing solution groups were compared for their effect on occlusion rates. Of the 50 subjects randomly assigned to the normal saline group, 3 (6%) experienced occlusions, all of whom were elderly women. There were no occlusions in the 52 subjects randomly assigned to the heparinized saline group. Although the occlusion rate findings were not statistically significant, the charges associated with replacing a PICC because of occlusion are economically relevant. The annualized savings attributable to heparinized saline use are $22,891.