Maintaining Short Peripheral Catheter Patency: A Comparison of Saline Lock Versus Continuous Infusion in the Acute Care Setting

Effects of the low-speed continuous infusion catheter technique on double-lumen central venous catheters: A randomized controlled trial

BACKGROUND

Central venous catheters are widely used in clinical practice, and the incidence of central venous catheter occlusion is between 25 % and 38 %. The turbulence caused by the pulsatile flushing technique is harmful to the vascular endothelium and may lead to phlebitis. The low-speed continuous infusion catheter technique is a new type of continuous infusion that ensures that the catheter is always in a keep-vein-open state by continuous low-speed flushing; hence, avoiding the problem of catheter occlusion.

OBJECTIVE

To investigate the effectiveness of the low-speed continuous infusion catheter technique and the routine care of double-lumen central venous catheters.

DESIGN

This was a prospective, randomized, controlled, open-label trial.

SETTING

Patients were recruited from 14 medical institutions in China between February and June 2023.

PARTICIPANTS

In total, 251 patients were recruited, with 125 in the intervention group and 126 in the control group.

METHODS

Patients who used double-lumen central venous catheters for infusion treatment were selected, and those who met the sampling criteria were randomly divided into intervention and control groups using the random envelope method. The intervention group used the low-speed continuous infusion catheter technique to maintain catheter patency, whereas the control group used routine care with a trial period of 7 days. The primary outcome was the occlusion rate. The secondary outcomes included nursing satisfaction and complication rates of the two groups.

RESULTS

After 7 days, the rate of catheter occlusion was 28.0 % (35/125, 95 % confidence interval (CI):0.203, 0.367) in the intervention group and 53.97 % (68/126, 95 % CI: 0.449-0.629) in the control group, with a statistically significant difference (χ2 = 17.488, p < 0.001); at 3 days of intervention, the rate of catheter blockage was 8.0 % (10/125, 95 % CI: 0.039-0.142) in the intervention group and 23.8 % (30/126, 0.167-0.322) in the control group, with a statistically significant difference (χ2 = 11.707, p < 0.001). Nurse satisfaction was significantly higher in the intervention group (115/125, 92.0 %, 95 % CI: 0.858-0.961) than in the control group (104/126, 82.54 %, 95 % CI: 0.748-0.887) (χ2 = 5.049, p = 0.025). There were no statistically significant complication rates in either group (p = 0.622).

CONCLUSION

The low-speed continuous infusion catheter technique helps maintain catheter patency, improves nurse satisfaction, and provides a high level of safety.

REGISTRATION

Chinese Clinical Trial Registry (ChiCTR2200064007, www.chictr.org.cn). The first recruitment was conducted in February. https://www.chictr.org.cn/showproj.html?proj=177311.

Heparin versus normal saline for the care of peripheral intravenous catheters in children: A meta-analysis

AIM

To conduct a meta-analysis to evaluate the role of heparin versus normal saline lock in the care of peripheral intravenous catheters.

DESIGN

A meta-analysis.

METHODS

This meta-analysis searched nine databases for randomized controlled trials (RCTs) on heparin versus normal saline for the care of peripheral intravenous catheters in children up to April 5, 2023. The quality of included RCTs was evaluated using the risk of bias tool of Cochrane library. RevMan5.3 software was used for data analysis.

RESULTS

Ten RCTs with a total of 1255 children were involved. Meta-analysis indicated that heparin lock reduced the incidence of blockage of peripheral intravenous catheter [OR = 2.01, 95% CI (1.42,2.84), p < 0.001], prolonged the duration of peripheral intravenous catheter indwelling[MD = -0.43, 95% CI (-0.75, -0.11), p = 0.008]. There were no statistical differences in the incidence of phlebitis [OR = 1.02, 95% CI (0.59, 1.74), p = 0.95 W].

PUBLIC CONTRIBUTION

Heparin may have more benefits in the nursing care of peripheral intravenous catheters compared with normal saline.

The flushing procedure in nursing practices: A cross-sectional study with Portuguese and Brazilian nurses

BACKGROUND

In patients with peripheral intravenous catheters (PIVCs), performing flushing is an essential procedure to maintain catheter patency and prevent complications. These PIVC related complications can lead to premature removal and therapeutics interruption, which implies the need of a new catheterization thus increasing patient discomfort and pain.

AIMS

To identify nursing practices related to the flushing procedure, namely: moment(s) of the flushing; the syringe size used; the flush solution, volume and technique; the knowledge and accomplishment of the recommended standards on flushing by nurses.

METHODS

A cross-sectional study was conducted between July and December 2017, with Brazilian and Portuguese nurses. An online questionnaire was developed based on the international recommendations on flushing procedure. Descriptive analysis was performed.

RESULTS

A total of 76 nurses answered the questionnaire. The majority of nurses (84.2%) performed flushing: the most common technique used was continuous syringe pressure (31.2%), with the push-pause technique being performed by 23.4% of the nurses. Despite the majority performs flushing at four distinct moments (after the PIVC insertion, before, between and after drug delivery), there are inconsistencies in flush solution, volume, and syringe size. The most used volume to perform flushing was 5 mL, filled using normal saline. Despite this, they also recognized the omission of this procedure due to time constrains, no familiarity with the procedure and unavailable material.

CONCLUSIONS

This study identified that flushing procedure isn't always performed by nurses in their clinical practice. Also, several inconsistencies were observed between nurses that performed flushing, reflecting the lack of empirical evidence in this area of research.

Randomized clinical trial analyzing maintenance of peripheral venous catheters in an internal medicine unit: Heparin vs. saline

Background

Peripheral venous catheters (PVCs) require adequate maintenance based on heparin or saline locks in order to prevent complications. Heparin has proven effective in central venous catheters, although its use in PVCs remains controversial. Our hypothesis was that saline locks are as effective as heparin locks in preventing problems with PVCs. The objective of the present study was to compare phlebitis and catheter tip colonization rates between PVCs locked with saline and those locked with heparin in patients admitted to an internal medicine department (IMD).

Methods

We performed a 19-month prospective, controlled, open-label, randomized clinical study of patients with at least 1 PVC admitted to the IMD of our hospital. The patients were randomized to receive saline solution (PosiFlush^®, group A) or heparin (Fibrilin^®, group B) for daily maintenance of the PVC. Clinical and microbiological data were monitored to investigate the frequency of phlebitis, catheter tip colonization, and catheter-related bloodstream infection (C-RBSI), as well as crude mortality, days of hospital stay, and days of antimicrobial treatment.

Results

We assessed 339 PVCs (241 patients), of which 192 (56.6%) were locked with saline (group A) and 147 (43.4%) with heparin (group B). The main demographic characteristics of the patients were distributed equally between the 2 study groups. The median (IQR) catheter days was 5 (3–8) for both groups (p = 0.64). The frequency of phlebitis was 17.7% for group A and 13.3% for group B (p = 0.30). The frequency of colonization of PVC tips was 14.6% and 12.2% in groups A and B, respectively (p = 0.63). Only 2 episodes of C-RBSI were detected (1 patient in group A). Saline lock was not an independent factor for phlebitis or catheter colonization.

Conclusions

Our study revealed no statistically significant differences in the frequency of phlebitis and catheter tip colonization between PVCs locked with saline and PVCs locked with heparin. We suggest that PVC can be maintained with saline solution, as it is safer and cheaper than heparin.

Nurses' Short Peripheral Catheter Flushing Practices: Implications for Patient Care, Nursing Education, and Policy

Nursing practice and institutional policies regarding short peripheral catheter (SPC) flushing vary. These variations result in a lack of understanding about the factors that influence nurses' SPC flushing practices and leave their effect on outcomes unexplored-information that could potentially enhance nurses' clinical education, institutional policy efforts, and patient care. Using a mixed-methods design, this study examined SPC flushing practices and outcomes among a cohort of medical-surgical nurses and explored their rationale for flushing. Trends were noted in the timing of flushes, and the factors that influenced nurses' SPC flushing practices included patient acuity, experience, and workload.

The effect of different flushing methods in a short peripheral catheter

Purpose

To develop a rabbit model of a short peripheral catheter (SPC) and to observe the effects of different flushing methods on blood vessels.

Methods

Thirty rabbits were randomly divided into three groups (A, B, and C), with ten rabbits per group. In group A, we used pulsed flush; in group B, we used uniform flush; and no treatment was used in group C.

Results

We observed that a uniform flush reduced blockage, phlebitis, and exudation compared to a pulsed flush by visual observation. The histopathological examination found that the morphological changes in group A were more severe than in group B and C related to loss of venous endothelial cells, inflammatory cell infiltration, edema, epidermal and chondrocyte degeneration, except for the thrombosis on group B that was more serious than in group A, especially in the distal side of puncture points. The distal region of groups A and B had more inflammatory cell infiltration than the proximal region. Thrombosis was more severe in the distal region than in the proximal region in group B.

Conclusions

The uniform flush produced less damage to the vascular endothelium and surrounding tissues and was superior to the pulsed flush. However, the uniform flush is prone to thrombosis.