1
|
Irigoyen PM, Jimenez MG, Arellano EML, Pérez MS, Cabredo RV. Patency, assessment, and management of central catheter occlusion in adult patients in the intensive care unit: a best practice implementation project. JBI Evid Implement 2024; 22:261-270. [PMID: 38666477 DOI: 10.1097/xeb.0000000000000426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2024]
Abstract
INTRODUCTION Cannulation with a central venous catheter (CVC) is a common procedure used in critical care. One of the main complications is occlusion, which can lead to delayed treatment, prolonged hospital stay, and increased health care costs. OBJECTIVE The aim of this project was to promote evidence-based practice for nurses caring for patients with a CVC in a Spanish intensive care unit. The project also aimed to reduce CVC occlusion and ensure CVC patency. METHODS This project was guided by the JBI Model of Evidence-based Healthcare and the JBI Evidence Implementation Framework. Seven phases were followed using evidence-based auditing and feedback. The JBI Practical Application of Clinical Evidence System (PACES) and Getting Research into Practice (GRiP) tools were used to support data collection, data analysis, and implementation planning. RESULTS After project implementation, the following results were obtained. Criterion 1 (assessing the CVC, flushing, and aspirating) reached 100% compliance in both audits. Criterion 2 (occlusion documentation) showed a modest improvement, rising from 13.33% to 36.67%. Improvement for Criterion 3 (the need for a policy and protocol) was excellent, rising from 0% at baseline to 100% following implementation. Criterion 4 (rapid instillation of an appropriate thrombolytic agent if a CVC is occluded) remained at 0% compliance in both audits. Criterion 5 (continuing education for health care professionals) improved from 10% to 60%. Criterion 6 (flushing and locking before procedures) improved from 90% to 100%. CONCLUSION The project objectives were largely met and resulted in a protocol, which has been shared with other departments within the hospital. The implementation of best clinical practice will be continued, including the use of thrombolytic agents. SPANISH ABSTRACT http://links.lww.com/IJEBH/A200.
Collapse
Affiliation(s)
| | - Marina Gallego Jimenez
- Spanish Centre for Evidence-Based Nursing and Healthcare: A JBI Centre of Excellence, Madrid, Spain
| | | | | | | |
Collapse
|
2
|
Fan CH, Chu CN, Chiu FH, Chen CT, Tung HH. Flushing and locking management related to central venous catheter occlusion rate among adult patients in acute care: a best practice implementation project. JBI Evid Implement 2024; 22:131-139. [PMID: 37982206 PMCID: PMC11107886 DOI: 10.1097/xeb.0000000000000394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
INTRODUCTION AND OBJECTIVES A central venous catheter (CVC)-a type of central venous access device (CVAD)-is the most common intervention for critical illnesses. Obstruction of the CVC can lead to fatal consequences. Thus, it is critical to maintain catheter lumen patency. The CVC occlusion rate in a hospital in Taiwan was 33%. This project aimed to decrease the CVC occlusion rate in acute care. METHODS This project was conceptually informed by the JBI Evidence-Based Model of Healthcare, in particular, the conceptualization of evidence implementation as inclusive of context analysis, implementation, and evaluation of outcomes using evidence-based quality indicators. As part of the seven-phase implementation process, we used audit and feedback in a pre- and post-test design to measure baseline compliance. Based on the initial audit, we developed an implementation strategy responsive to the identified gaps in compliance. We then undertook a final audit to measure changes in compliance to evaluate our implementation effects. The JBI software, PACES, and the situational analysis software, GRiP, were used for data collection and implementation planning. There were six evidence-based criteria, with a sample size of 30 nurses for each criterion. The team carried out the project from September 2022 to January 2023. RESULTS Post-implementation audit compliance rates increased to 100% for the following criteria: the organization had a standardized flushing and locking solution protocol (0%), the CVAD lumen was locked upon completion of the final flush (10%), a single-dose system was used for flushing and locking the CVAD (60%), and preservative-free 0.9% sodium chloride was used to flush the CVAD (60%). Furthermore, the CVC occlusion rate decreased from 33% to 5%. CONCLUSIONS The project successfully decreased the rate of CVC occlusion and increased the competence of nurses in acute care settings. The implementation of best practices in clinical care should focus on leadership, cross-department coordination, education, and innovation.
Collapse
Affiliation(s)
- Chia-Hao Fan
- Department of Nursing, Hualien Tzu Chi Hospital, Hualien, Taiwan
- College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chung-Ning Chu
- Department of Nursing, Hualien Armed Forces General Hospital, Hualien, Taiwan
| | - Feng-Han Chiu
- Emergency Department, Hualien Armed Forces General Hospital, Hualien, Taiwan
| | - Chia-Te Chen
- Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Heng-Hsin Tung
- College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan
| |
Collapse
|
3
|
Gündogdu F, Semerci R, Bay F. Totally Implantable Venous Access Device Care Practices and Experiences of Pediatric and Adult Oncology Nurses. JOURNAL OF INFUSION NURSING 2024; 47:182-189. [PMID: 38744243 DOI: 10.1097/nan.0000000000000547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
This study aimed to determine the practices of nurses working in pediatric and adult oncology clinics regarding totally implantable venous access device (TIVAD) care. The descriptive study was conducted with 227 oncology nurse members of the Oncology Nursing Association. The data were collected online with a survey form, which included questions about the participants' sociodemographic characteristics, professional experience, and TIVAD implementation practices. Descriptive statistics and ꭓ2 tests were used for the analysis of the data. It was determined that 44.1% of the nurses used 0.9% NaCl for active TIVAD flushing; 15.9% of them used a positive-pressure 0.9% NaCl-filled syringe; 12.3% used antireflux connectors; 85.5% used manual positive pressure technique; and 53.7% used the pulsatile technique. A statistical difference was found between nurses' training on TIVAD care and TIVAD occlusion rate in the clinic, TIVAD infection rate, following the guidelines, and using the pulsatile technique (P < .05). This study revealed that there are differences in the practices for TIVAD care and that the recommendations in the literature/guidelines are not implemented at the desired level to ensure continuity and prevent complications.
Collapse
Affiliation(s)
- Fatma Gündogdu
- Author Affiliations: Department of Nursing, School of Health Sciences, KTO Karatay University, Konya, Türkiye (Gündogdu); School of Nursing, Koç University, İstanbul, Türkiye (Semerci); Gazi University Hospital, Ankara, Türkiye (Bay)
- Fatma Gündogdu is an assistant professor in the Department of Nursing at KTO Karatay University. She specializes in adult cancer and symptom management. Her research and teaching focus on the management of chemotherapy and radiotherapy-induced symptoms and on reducing these symptoms with nonpharmacological methods. She has been a member of the Turkish Oncology Nursing Society for 27 years and is a member of the board. Currently, she is a board member of the Oncology Nursing Association and is the coordinator of both the research and the geriatric hematologic oncology nursing working commissions. She has collaborated with the Ministry of Health in developing guidelines for the safe use of antineoplastic drugs in Türkiye. Furthermore, she pioneered the development of the chemotherapy nursing certificate program and, subsequently, the oncology nursing certificate program in Türkiye. Remziye Semerci is an assistant professor in the Department of Pediatric Nursing at Koç University. She is interested in childhood cancer and symptom management. Her research and teaching focus on the management of chemotherapy-induced symptoms and reducing these symptoms with nonpharmacological methods. She is a member of the Turkey Oncology Nursing Society; additionally, she takes a role in some commissions, including the Pediatric Oncology Group (group secretary) and Research Group (group secretary). She is a Turkish representative of the Young Cancer Nurses Network and a member of the SIOP Nursing Working Group. Figen Bay is a specialist nurse and has worked as a nurse at a university hospital for 28 years. She served as the charge nurse for the Oncology Hematology Clinic for many years. She has been a board member of the Turkish Oncology Nursing Society for 22 years and has served as the society's president for the last 6 years. Ms. Bay has attended numerous national and international congresses and courses in the field of oncology, authored several book chapters, and holds the authority responsible for the Ministry of Health-approved Oncology Nursing Certification training program. Actively involved in planning and implementing training programs nationwide, in every region and province, she aims to educate nurses in the field of oncology and to enhance the quality of oncology patient care
| | - Remziye Semerci
- Author Affiliations: Department of Nursing, School of Health Sciences, KTO Karatay University, Konya, Türkiye (Gündogdu); School of Nursing, Koç University, İstanbul, Türkiye (Semerci); Gazi University Hospital, Ankara, Türkiye (Bay)
- Fatma Gündogdu is an assistant professor in the Department of Nursing at KTO Karatay University. She specializes in adult cancer and symptom management. Her research and teaching focus on the management of chemotherapy and radiotherapy-induced symptoms and on reducing these symptoms with nonpharmacological methods. She has been a member of the Turkish Oncology Nursing Society for 27 years and is a member of the board. Currently, she is a board member of the Oncology Nursing Association and is the coordinator of both the research and the geriatric hematologic oncology nursing working commissions. She has collaborated with the Ministry of Health in developing guidelines for the safe use of antineoplastic drugs in Türkiye. Furthermore, she pioneered the development of the chemotherapy nursing certificate program and, subsequently, the oncology nursing certificate program in Türkiye. Remziye Semerci is an assistant professor in the Department of Pediatric Nursing at Koç University. She is interested in childhood cancer and symptom management. Her research and teaching focus on the management of chemotherapy-induced symptoms and reducing these symptoms with nonpharmacological methods. She is a member of the Turkey Oncology Nursing Society; additionally, she takes a role in some commissions, including the Pediatric Oncology Group (group secretary) and Research Group (group secretary). She is a Turkish representative of the Young Cancer Nurses Network and a member of the SIOP Nursing Working Group. Figen Bay is a specialist nurse and has worked as a nurse at a university hospital for 28 years. She served as the charge nurse for the Oncology Hematology Clinic for many years. She has been a board member of the Turkish Oncology Nursing Society for 22 years and has served as the society's president for the last 6 years. Ms. Bay has attended numerous national and international congresses and courses in the field of oncology, authored several book chapters, and holds the authority responsible for the Ministry of Health-approved Oncology Nursing Certification training program. Actively involved in planning and implementing training programs nationwide, in every region and province, she aims to educate nurses in the field of oncology and to enhance the quality of oncology patient care
| | - Figen Bay
- Author Affiliations: Department of Nursing, School of Health Sciences, KTO Karatay University, Konya, Türkiye (Gündogdu); School of Nursing, Koç University, İstanbul, Türkiye (Semerci); Gazi University Hospital, Ankara, Türkiye (Bay)
- Fatma Gündogdu is an assistant professor in the Department of Nursing at KTO Karatay University. She specializes in adult cancer and symptom management. Her research and teaching focus on the management of chemotherapy and radiotherapy-induced symptoms and on reducing these symptoms with nonpharmacological methods. She has been a member of the Turkish Oncology Nursing Society for 27 years and is a member of the board. Currently, she is a board member of the Oncology Nursing Association and is the coordinator of both the research and the geriatric hematologic oncology nursing working commissions. She has collaborated with the Ministry of Health in developing guidelines for the safe use of antineoplastic drugs in Türkiye. Furthermore, she pioneered the development of the chemotherapy nursing certificate program and, subsequently, the oncology nursing certificate program in Türkiye. Remziye Semerci is an assistant professor in the Department of Pediatric Nursing at Koç University. She is interested in childhood cancer and symptom management. Her research and teaching focus on the management of chemotherapy-induced symptoms and reducing these symptoms with nonpharmacological methods. She is a member of the Turkey Oncology Nursing Society; additionally, she takes a role in some commissions, including the Pediatric Oncology Group (group secretary) and Research Group (group secretary). She is a Turkish representative of the Young Cancer Nurses Network and a member of the SIOP Nursing Working Group. Figen Bay is a specialist nurse and has worked as a nurse at a university hospital for 28 years. She served as the charge nurse for the Oncology Hematology Clinic for many years. She has been a board member of the Turkish Oncology Nursing Society for 22 years and has served as the society's president for the last 6 years. Ms. Bay has attended numerous national and international congresses and courses in the field of oncology, authored several book chapters, and holds the authority responsible for the Ministry of Health-approved Oncology Nursing Certification training program. Actively involved in planning and implementing training programs nationwide, in every region and province, she aims to educate nurses in the field of oncology and to enhance the quality of oncology patient care
| |
Collapse
|
4
|
Warkentin TE. Autoimmune Heparin-Induced Thrombocytopenia. J Clin Med 2023; 12:6921. [PMID: 37959386 PMCID: PMC10649402 DOI: 10.3390/jcm12216921] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 10/27/2023] [Accepted: 11/01/2023] [Indexed: 11/15/2023] Open
Abstract
Autoimmune thrombocytopenia (aHIT) is a severe subtype of heparin-induced thrombocytopenia (HIT) with atypical clinical features caused by highly pathological IgG antibodies ("aHIT antibodies") that activate platelets even in the absence of heparin. The clinical features of aHIT include: the onset or worsening of thrombocytopenia despite stopping heparin ("delayed-onset HIT"), thrombocytopenia persistence despite stopping heparin ("persisting" or "refractory HIT"), or triggered by small amounts of heparin (heparin "flush" HIT), most cases of fondaparinux-induced HIT, and patients with unusually severe HIT (e.g., multi-site or microvascular thrombosis, overt disseminated intravascular coagulation [DIC]). Special treatment approaches are required. For example, unlike classic HIT, heparin cessation does not result in de-escalation of antibody-induced hemostasis activation, and thus high-dose intravenous immunoglobulin (IVIG) may be indicated to interrupt aHIT-induced platelet activation; therapeutic plasma exchange may be required if high-dose IVIG is ineffective. Also, aHIT patients are at risk for treatment failure with (activated partial thromboplastin time [APTT]-adjusted) direct thrombin inhibitor (DTI) therapy (argatroban, bivalirudin), either because of APTT confounding (where aHIT-associated DIC and resulting APTT prolongation lead to systematic underdosing/interruption of DTI therapy) or because DTI inhibits thrombin-induced protein C activation. Most HIT laboratories do not test for aHIT antibodies, contributing to aHIT under-recognition.
Collapse
Affiliation(s)
- Theodore E. Warkentin
- Department of Pathology and Molecular Medicine and Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON L8N 3Z5, Canada; ; Tel.: +1-(905)-527-0271 (ext. 46139)
- Service of Benign Hematology, Hamilton Health Sciences (General Site), Hamilton, ON L8L 2X2, Canada
- Transfusion Medicine, Hamilton Regional Laboratory Medicine Program, Hamilton, ON L8L 2X2, Canada
| |
Collapse
|
5
|
Ornowska M, Smithman J, Reynolds S. Locking solutions for prevention of central venous access device complications in the adult critical care population: A systematic review. PLoS One 2023; 18:e0289938. [PMID: 37824460 PMCID: PMC10569507 DOI: 10.1371/journal.pone.0289938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 07/23/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND The objective of this systematic review is to determine the extent and quality of evidence for use of different types of locking fluids to prevent central venous access device complications in adult critical care patients. Specifically, rates of catheter-related bloodstream infection, colonization, and occlusion were considered. All types of devices were included in the review: central venous catheters, peripherally- inserted central catheters and hemodialysis catheters. METHODS Eligibility criteria. Papers had to include adult (>18 years old) critical care patients, be experimental trials, conducted in North America and Europe, and published in peer-reviewed journals from 2010 onwards. Information sources. A search of Medline and EMBASE databases was performed. The search is current as of November 28th, 2022. Risk of bias. The Cochrane Risk of Bias 2 and the Risk of Bias In Non-Randomized Studies of Intervention tools were used to assess the risk of bias in included studies. RESULTS Included studies. A total of 240 paper titles and abstracts underwent review, of these seven studies met the final criteria for quality appraisal. A total of three studies earned a low risk of bias quality appraisal. DISCUSSION Limitations of evidence. Due to heterogeneity of types of locking fluids investigated and small number of studies identified, meta-analysis of results was not possible. Interpretation. Out of all fluids investigated, only citrate 46.7% was found to statistically reduce central venous access device complication rates. This systematic review has also identified a gap in the literature regarding studies of locking fluids that are adequately powered in this patient population. FUTURE DIRECTIONS Future research should include investigations and use of novel locking fluids with more effective properties against complications. It is imperative that future studies are adequately powered, randomized controlled trials in this patient population to facilitate optimal evidence-based care.
Collapse
Affiliation(s)
- Marlena Ornowska
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
| | - Joshua Smithman
- Department of Biology, Simon Fraser University, Burnaby, BC, Canada
| | - Steven Reynolds
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
- Fraser Health Authority, Royal Columbian Hospital, New Westminster, BC, Canada
| |
Collapse
|
6
|
Ribeiro GDSR, Campos JF, Camerini FG, Parreira PMSD, da Silva RC. Flushing in Intravenous Catheters: Observational Study of Nursing Practice in Intensive Care in Brazil. JOURNAL OF INFUSION NURSING 2023; 46:272-280. [PMID: 37611285 DOI: 10.1097/nan.0000000000000516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
An observational study was developed with 108 nursing professionals who managed vascular access devices in 4 intensive care units of a university hospital in Rio de Janeiro, Brazil. The objective was to analyze the practice of the nursing staff in performing flushing for the maintenance of vascular access devices in critically ill patients. Data were collected by observing the flushing procedure using a structured checklist and analyzed using descriptive and inferential statistics. In 23% of the 404 observations, there was no flushing. When performed at some point during catheter management (77%), flushing was predominant after drug administration with 1 or 2 drugs administered. There were flaws in the flushing technique applied in terms of volume and method of preparation. Time of professional experience >5 years, knowledge about recommendations, and training on flushing were variables associated with technique performance. It was concluded that the flushing procedure did not meet the recommendations of good practices, with failures that constituted medication errors.
Collapse
Affiliation(s)
- Gabriella da Silva Rangel Ribeiro
- Gabriella da Silva Rangel Ribero, RN, is a PhD candidate in nursing, Anna Nery School of Nursing, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil. She is a specialist in intensive care nursing from the State University of Rio de Janeiro and member of the research group "Representations and Practices of Health Care and Nursing." Ms da Silva Rangel Ribero is a nurse in the area of health policies at the United Health Group with clinical experience in the area of Intensive Care Nursing, with publications and research interests focused on the themes of health technology, patient safety, and infusion therapy
- Juliana Faria Campos, PhD, is an associate professor at Anna Nery School of Nursing, UFRJ, and leader of the research group "Technologies and Conceptions for the Systematization of Nursing Care." She is coordinator of the multiuser Skills Laboratory of the Health Sciences Center at the Federal University of Rio de Janeiro and permanent professor of the Graduate Program in Nursing of the Anna Nery School of Nursing, UFRJ (Masters and PhD), with research projects and publications on the themes of clinical simulation, intensive care, and patient safety. Dr Faria Campos is also a reviewer of scientific journals and has clinical experience in intensive care nursing
- Flávia Giron Camerini, PhD, is an associate professor at the School of Nursing of the State University of Rio de Janeiro (UERJ), and leader of the research group "Health Technology and Nursing in the Context of Patient Safety in the Hospital Environment." She is a member of the Scientific Committee of the Brazilian Society of Quality and Patient Safety and permanent professor of the graduate program at the School of Nursing of UERJ (Master's and PhD). Dr Giron Camerini is associate editor of the Brazilian journal, Texto e Contexto Enfermagem, and ad hoc reviewer for various scientific journals. She has clinical experience in intensive care nursing, with several research projects and publications on drug therapy safety
- Pedro Miguel Santos Dinis Parreira, PhD, is a researcher at the Health Sciences/Nursing Research Unit of the Nursing School of Coimbra, Portugal. He is coordinator of the Entrepreneurship Office of the Nursing School of Coimbra and coordinates several funded research projects and has several international publications on the development of technologies and innovations for professional practice in nursing and on entrepreneurship
- Rafael Celestino da Silva, PhD, is an associate professor at Anna Nery School of Nursing, Federal UFRJ, and leader of the research group "Representations and Practices of Health Care and Nursing." Dr Celestino da Silva is a permanent professor at the graduate program of the Anna Nery School of Nursing at UFRJ (Master's and PhD), with several research projects and publications on care technologies, professional practices, and patient safety in the context of intensive care. He is an editor at the Brazilian Journal of Nursing, ad hoc reviewer of several scientific journals, and has clinical experience in the area of Medical-Surgical Nursing
| | - Juliana Faria Campos
- Gabriella da Silva Rangel Ribero, RN, is a PhD candidate in nursing, Anna Nery School of Nursing, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil. She is a specialist in intensive care nursing from the State University of Rio de Janeiro and member of the research group "Representations and Practices of Health Care and Nursing." Ms da Silva Rangel Ribero is a nurse in the area of health policies at the United Health Group with clinical experience in the area of Intensive Care Nursing, with publications and research interests focused on the themes of health technology, patient safety, and infusion therapy
- Juliana Faria Campos, PhD, is an associate professor at Anna Nery School of Nursing, UFRJ, and leader of the research group "Technologies and Conceptions for the Systematization of Nursing Care." She is coordinator of the multiuser Skills Laboratory of the Health Sciences Center at the Federal University of Rio de Janeiro and permanent professor of the Graduate Program in Nursing of the Anna Nery School of Nursing, UFRJ (Masters and PhD), with research projects and publications on the themes of clinical simulation, intensive care, and patient safety. Dr Faria Campos is also a reviewer of scientific journals and has clinical experience in intensive care nursing
- Flávia Giron Camerini, PhD, is an associate professor at the School of Nursing of the State University of Rio de Janeiro (UERJ), and leader of the research group "Health Technology and Nursing in the Context of Patient Safety in the Hospital Environment." She is a member of the Scientific Committee of the Brazilian Society of Quality and Patient Safety and permanent professor of the graduate program at the School of Nursing of UERJ (Master's and PhD). Dr Giron Camerini is associate editor of the Brazilian journal, Texto e Contexto Enfermagem, and ad hoc reviewer for various scientific journals. She has clinical experience in intensive care nursing, with several research projects and publications on drug therapy safety
- Pedro Miguel Santos Dinis Parreira, PhD, is a researcher at the Health Sciences/Nursing Research Unit of the Nursing School of Coimbra, Portugal. He is coordinator of the Entrepreneurship Office of the Nursing School of Coimbra and coordinates several funded research projects and has several international publications on the development of technologies and innovations for professional practice in nursing and on entrepreneurship
- Rafael Celestino da Silva, PhD, is an associate professor at Anna Nery School of Nursing, Federal UFRJ, and leader of the research group "Representations and Practices of Health Care and Nursing." Dr Celestino da Silva is a permanent professor at the graduate program of the Anna Nery School of Nursing at UFRJ (Master's and PhD), with several research projects and publications on care technologies, professional practices, and patient safety in the context of intensive care. He is an editor at the Brazilian Journal of Nursing, ad hoc reviewer of several scientific journals, and has clinical experience in the area of Medical-Surgical Nursing
| | - Flávia Giron Camerini
- Gabriella da Silva Rangel Ribero, RN, is a PhD candidate in nursing, Anna Nery School of Nursing, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil. She is a specialist in intensive care nursing from the State University of Rio de Janeiro and member of the research group "Representations and Practices of Health Care and Nursing." Ms da Silva Rangel Ribero is a nurse in the area of health policies at the United Health Group with clinical experience in the area of Intensive Care Nursing, with publications and research interests focused on the themes of health technology, patient safety, and infusion therapy
- Juliana Faria Campos, PhD, is an associate professor at Anna Nery School of Nursing, UFRJ, and leader of the research group "Technologies and Conceptions for the Systematization of Nursing Care." She is coordinator of the multiuser Skills Laboratory of the Health Sciences Center at the Federal University of Rio de Janeiro and permanent professor of the Graduate Program in Nursing of the Anna Nery School of Nursing, UFRJ (Masters and PhD), with research projects and publications on the themes of clinical simulation, intensive care, and patient safety. Dr Faria Campos is also a reviewer of scientific journals and has clinical experience in intensive care nursing
- Flávia Giron Camerini, PhD, is an associate professor at the School of Nursing of the State University of Rio de Janeiro (UERJ), and leader of the research group "Health Technology and Nursing in the Context of Patient Safety in the Hospital Environment." She is a member of the Scientific Committee of the Brazilian Society of Quality and Patient Safety and permanent professor of the graduate program at the School of Nursing of UERJ (Master's and PhD). Dr Giron Camerini is associate editor of the Brazilian journal, Texto e Contexto Enfermagem, and ad hoc reviewer for various scientific journals. She has clinical experience in intensive care nursing, with several research projects and publications on drug therapy safety
- Pedro Miguel Santos Dinis Parreira, PhD, is a researcher at the Health Sciences/Nursing Research Unit of the Nursing School of Coimbra, Portugal. He is coordinator of the Entrepreneurship Office of the Nursing School of Coimbra and coordinates several funded research projects and has several international publications on the development of technologies and innovations for professional practice in nursing and on entrepreneurship
- Rafael Celestino da Silva, PhD, is an associate professor at Anna Nery School of Nursing, Federal UFRJ, and leader of the research group "Representations and Practices of Health Care and Nursing." Dr Celestino da Silva is a permanent professor at the graduate program of the Anna Nery School of Nursing at UFRJ (Master's and PhD), with several research projects and publications on care technologies, professional practices, and patient safety in the context of intensive care. He is an editor at the Brazilian Journal of Nursing, ad hoc reviewer of several scientific journals, and has clinical experience in the area of Medical-Surgical Nursing
| | - Pedro Miguel Santos Dinis Parreira
- Gabriella da Silva Rangel Ribero, RN, is a PhD candidate in nursing, Anna Nery School of Nursing, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil. She is a specialist in intensive care nursing from the State University of Rio de Janeiro and member of the research group "Representations and Practices of Health Care and Nursing." Ms da Silva Rangel Ribero is a nurse in the area of health policies at the United Health Group with clinical experience in the area of Intensive Care Nursing, with publications and research interests focused on the themes of health technology, patient safety, and infusion therapy
- Juliana Faria Campos, PhD, is an associate professor at Anna Nery School of Nursing, UFRJ, and leader of the research group "Technologies and Conceptions for the Systematization of Nursing Care." She is coordinator of the multiuser Skills Laboratory of the Health Sciences Center at the Federal University of Rio de Janeiro and permanent professor of the Graduate Program in Nursing of the Anna Nery School of Nursing, UFRJ (Masters and PhD), with research projects and publications on the themes of clinical simulation, intensive care, and patient safety. Dr Faria Campos is also a reviewer of scientific journals and has clinical experience in intensive care nursing
- Flávia Giron Camerini, PhD, is an associate professor at the School of Nursing of the State University of Rio de Janeiro (UERJ), and leader of the research group "Health Technology and Nursing in the Context of Patient Safety in the Hospital Environment." She is a member of the Scientific Committee of the Brazilian Society of Quality and Patient Safety and permanent professor of the graduate program at the School of Nursing of UERJ (Master's and PhD). Dr Giron Camerini is associate editor of the Brazilian journal, Texto e Contexto Enfermagem, and ad hoc reviewer for various scientific journals. She has clinical experience in intensive care nursing, with several research projects and publications on drug therapy safety
- Pedro Miguel Santos Dinis Parreira, PhD, is a researcher at the Health Sciences/Nursing Research Unit of the Nursing School of Coimbra, Portugal. He is coordinator of the Entrepreneurship Office of the Nursing School of Coimbra and coordinates several funded research projects and has several international publications on the development of technologies and innovations for professional practice in nursing and on entrepreneurship
- Rafael Celestino da Silva, PhD, is an associate professor at Anna Nery School of Nursing, Federal UFRJ, and leader of the research group "Representations and Practices of Health Care and Nursing." Dr Celestino da Silva is a permanent professor at the graduate program of the Anna Nery School of Nursing at UFRJ (Master's and PhD), with several research projects and publications on care technologies, professional practices, and patient safety in the context of intensive care. He is an editor at the Brazilian Journal of Nursing, ad hoc reviewer of several scientific journals, and has clinical experience in the area of Medical-Surgical Nursing
| | - Rafael Celestino da Silva
- Gabriella da Silva Rangel Ribero, RN, is a PhD candidate in nursing, Anna Nery School of Nursing, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil. She is a specialist in intensive care nursing from the State University of Rio de Janeiro and member of the research group "Representations and Practices of Health Care and Nursing." Ms da Silva Rangel Ribero is a nurse in the area of health policies at the United Health Group with clinical experience in the area of Intensive Care Nursing, with publications and research interests focused on the themes of health technology, patient safety, and infusion therapy
- Juliana Faria Campos, PhD, is an associate professor at Anna Nery School of Nursing, UFRJ, and leader of the research group "Technologies and Conceptions for the Systematization of Nursing Care." She is coordinator of the multiuser Skills Laboratory of the Health Sciences Center at the Federal University of Rio de Janeiro and permanent professor of the Graduate Program in Nursing of the Anna Nery School of Nursing, UFRJ (Masters and PhD), with research projects and publications on the themes of clinical simulation, intensive care, and patient safety. Dr Faria Campos is also a reviewer of scientific journals and has clinical experience in intensive care nursing
- Flávia Giron Camerini, PhD, is an associate professor at the School of Nursing of the State University of Rio de Janeiro (UERJ), and leader of the research group "Health Technology and Nursing in the Context of Patient Safety in the Hospital Environment." She is a member of the Scientific Committee of the Brazilian Society of Quality and Patient Safety and permanent professor of the graduate program at the School of Nursing of UERJ (Master's and PhD). Dr Giron Camerini is associate editor of the Brazilian journal, Texto e Contexto Enfermagem, and ad hoc reviewer for various scientific journals. She has clinical experience in intensive care nursing, with several research projects and publications on drug therapy safety
- Pedro Miguel Santos Dinis Parreira, PhD, is a researcher at the Health Sciences/Nursing Research Unit of the Nursing School of Coimbra, Portugal. He is coordinator of the Entrepreneurship Office of the Nursing School of Coimbra and coordinates several funded research projects and has several international publications on the development of technologies and innovations for professional practice in nursing and on entrepreneurship
- Rafael Celestino da Silva, PhD, is an associate professor at Anna Nery School of Nursing, Federal UFRJ, and leader of the research group "Representations and Practices of Health Care and Nursing." Dr Celestino da Silva is a permanent professor at the graduate program of the Anna Nery School of Nursing at UFRJ (Master's and PhD), with several research projects and publications on care technologies, professional practices, and patient safety in the context of intensive care. He is an editor at the Brazilian Journal of Nursing, ad hoc reviewer of several scientific journals, and has clinical experience in the area of Medical-Surgical Nursing
| |
Collapse
|
7
|
Deng Y, Xing J, Tan Z, Ai X, Li Y, Zhang L. Clinical application of 4% sodium citrate and heparin in the locking of central venous catheters (excluding dialysis catheters) in intensive care unit patients: A pragmatic randomized controlled trial. PLoS One 2023; 18:e0288117. [PMID: 37399185 DOI: 10.1371/journal.pone.0288117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 06/13/2023] [Indexed: 07/05/2023] Open
Abstract
OBJECTIVES The feasibility of utilizing 4% sodium citrate as an alternative locking solution for central venous catheters (CVCs) (excluding dialysis catheters) was assessed. METHODS Using heparin saline and 4% sodium citrate as locking solution, then 152 patients in ICU undergoing infusion with central venous catheters, were randomly assigned to receive either 10 U/mL heparin saline or 4% sodium citrate. The used outcome indicators include: four indexes of blood coagulation at 10 minutes after locking and 7 d after the first locking, bleeding around the puncture site and subcutaneous hematoma rate, gastrointestinal bleeding rate, catheter indwelling time, catheter occlusion rate, catheter-related bloodstream infection (CRBSI) rate, rate of ionized calcium < 1.0 mmol/L. The main outcome indicator was the activated partial thromboplastin time (APTT) at 10 min after tube locking. The trial was approved by relevant authorities (Chinese Clinical Trial Registry, no: ChiCTR2200056615, registered on February 9, 2022, http://www.chictr.org.cn; Ethics Committee of People's Hospital of Zhongjiang County, no: JLS-2021-034, approved at May 10, 2021, and no: JLS-2022-027, approved at May 30, 2022). RESULTS Among the main outcome measures, the heparin group showed a significant increase in APTT compared to the sodium citrate group at 10 min after locking (LSMD = 8.15, 95%Cl 7.1 to 9.2, P < 0.001). Among the secondary outcome measures, the heparin group demonstrated a significant increase in prothrombin time (PT) compared to the sodium citrate group at 10 minutes after locking (LSMD = 0.86, 95%CI 0.12 to 1.61, P = 0.024). It is found that APTT (LSMD = 8.05, 95%CI 6.71 to 9.4, P < 0.001), PT (LSMD = 0.78, 95%CI 0.14 to 1.42, P = 0.017) and fibrinogen (FB) (LSMD = 1.15, 95%CI 0.23 to 2.08, P = 0.014) at 7 d after locking are increased in the heparin group compared to sodium citrate group. There was no significant difference in catheter indwelling time between the two groups (P = 0.456). The incidence of catheter blockage was lower in sodium citrate group (RR = 0.36, 95%CI 0.15 to 0.87, P = 0.024). No CRBSI occurred in the two groups. Among the safety evaluation indexes, the incidence of bleeding around the puncture site and subcutaneous hematoma was lower in sodium citrate group (RR = 0.1, 95%CI 0.01 to 0.77, P = 0.027). There was no significant difference in the incidence of calcium ion < 1.0 mmol/L between the two groups (P = 0.333). CONCLUSIONS In ICU patients using CVCs (excluding dialysis catheters) infusion, employing 4% sodium citrate as a locking liquid can reduce the risk of bleeding and catheter occlusion without any hypocalcemia.
Collapse
Affiliation(s)
- Yuchun Deng
- Intensive Care Unit, People's Hospital of Zhongjiang County, Zhongjiang County, Sichuan Province, China
| | - Jie Xing
- School of materials science and engineering, Sichuan University, Chengdu, China
| | - Zhi Tan
- School of materials science and engineering, Sichuan University, Chengdu, China
| | - Xiaohua Ai
- Intensive Care Unit, People's Hospital of Zhongjiang County, Zhongjiang County, Sichuan Province, China
| | - Yi Li
- Intensive Care Unit, People's Hospital of Zhongjiang County, Zhongjiang County, Sichuan Province, China
| | - Liqin Zhang
- Intensive Care Unit, People's Hospital of Zhongjiang County, Zhongjiang County, Sichuan Province, China
| |
Collapse
|
8
|
Pizzoferrato M, Puca P, Ennas S, Cammarota G, Guidi L. Glucagon-like peptide-2 analogues for Crohn’s disease patients with short bowel syndrome and intestinal failure. World J Gastroenterol 2022; 28:6258-6270. [PMID: 36504557 PMCID: PMC9730438 DOI: 10.3748/wjg.v28.i44.6258] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 11/01/2022] [Accepted: 11/17/2022] [Indexed: 02/06/2023] Open
Abstract
Short bowel syndrome (SBS) with intestinal failure (IF) is a rare but severe complication of Crohn’s disease (CD), which is the most frequent benign condition that leads to SBS after repeated surgical resections, even in the era of biologics and small molecules. Glucagon-like peptide-2 analogues have been deeply studied recently for the treatment of SBS-IF. These drugs have a significant intestinotrophic effect and the potential to reduce the chronic dependence of SBS-IF patients on parenteral support or nutrition. Teduglutide has been approved for the treatment of SBS-IF, and apraglutide is currently in clinical development. The use of these drugs was examined with a focus on their use in CD patients.
Collapse
Affiliation(s)
- Marco Pizzoferrato
- UOC Gastroenterologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
| | - Pierluigi Puca
- UOC Gastroenterologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Sara Ennas
- UOC Gastroenterologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
| | - Giovanni Cammarota
- UOC Gastroenterologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Luisa Guidi
- UOC Gastroenterologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
| |
Collapse
|
9
|
Implementation of an Evidence-Based Practice Change Removing Heparin From Implanted Vascular Access Devices. JOURNAL OF INFUSION NURSING 2022; 45:258-263. [PMID: 36112873 DOI: 10.1097/nan.0000000000000482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The objective of this article was to describe the implementation and outcomes of an evidence-based practice change to remove heparin from implanted vascular access device (IVAD) management. An extensive search of the literature was performed, and articles were appraised and synthesized to determine the best practice. A common theme emerged from the literature, showing that 0.9% sodium chloride alone can be as effective as heparin in preventing occlusion in IVADs. In this nurse-led initiative, heparin was successfully removed from the IVAD deaccess process and replaced with a 0.9% sodium chloride flush using a pulsatile flushing technique. Alteplase administration rates were used to measure success of the project, with no statistically significant change observed in alteplase rates 6 mo postimplementation. Successful implementation of this practice change demonstrates that 0.9% sodium chloride may be used for IVAD lock when deaccessing.
Collapse
|
10
|
Ziyaeifard M, Ferasat-Kish R, Azarfarin R, Aghdaii N, Nejatisini H, Azadi Ahmadabadi C, Yousefi M. Comparison of the Effect of Heparinized Normal Saline Solution Versus Saline Solutions in Arterial and Central Venous Catheters on Complete Blood Count After Cardiac Surgery. Anesth Pain Med 2022; 12:e113345. [PMID: 37533479 PMCID: PMC10392822 DOI: 10.5812/aapm-113345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 02/28/2022] [Accepted: 03/02/2022] [Indexed: 08/04/2023] Open
Abstract
Background Heparinized and saline solutions can prevent clot formation in arterial and central venous catheters. However, heparin can decrease the platelet count and induce thrombocytopenia. Patients undergoing cardiac surgeries are more likely to develop heparin-induced thrombocytopenia. Objectives This study aimed to investigate the effect of heparinized and saline solutions of arterial and central venous catheters on complete blood count (CBC) after cardiac surgery. Methods This randomized controlled trial was conducted on 100 participants. All subjects underwent cardiac surgery at Rajaie Cardiovascular, Medical, and Research Center, Tehran, Iran. Patients were randomly divided into two groups intervention (A) for whom heparinized normal saline solution was used to maintain central arterial and venous catheters, and control (B) for whom normal saline solution was used. The CBC of subjects was monitored for three days (before surgery and the first and second days after surgery). Results In the present study, there were no significant differences between CBC, white blood cell differential count, prothrombin time, partial thromboplastin time (PTT), and international normalized ratio in groups A and B. However, we found significant differences in platelet count (P = 0.049), red blood cell count (P = 0.0001), hemoglobin (P = 0.0001), and hematocrit (P = 0.0001) between before surgery and the second day after surgery in group A. Platelet count (P = 0.027) and PTT (P = 0.0001) before and after surgery were significantly different in group B. Conclusions According to the results of this study, normal saline solution catheters have fewer side effects and can be a suitable replacement for heparinized catheters.
Collapse
Affiliation(s)
- Mohsen Ziyaeifard
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Rasool Ferasat-Kish
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Rasoul Azarfarin
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Nahid Aghdaii
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hasan Nejatisini
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Changiz Azadi Ahmadabadi
- Department of Surgery, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Marziyeh Yousefi
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
11
|
López-Briz E, Ruiz Garcia V, Cabello JB, Bort-Martí S, Carbonell Sanchis R. Heparin versus 0.9% sodium chloride locking for prevention of occlusion in central venous catheters in adults. Cochrane Database Syst Rev 2022; 7:CD008462. [PMID: 35849083 PMCID: PMC9291254 DOI: 10.1002/14651858.cd008462.pub4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Intermittent locking of central venous catheters (CVCs) is undertaken to help maintain their patency and performance. There are systematic variations in care: some practitioners use heparin (at different concentrations), whilst others use 0.9% sodium chloride (normal saline). This review looks at the effectiveness and safety of intermittent locking with heparin compared to normal saline, to see if the evidence establishes whether one is better than the other. This is an update of an earlier Cochrane Review. OBJECTIVES To evaluate the benefits and harms of intermittent locking of CVCs with heparin versus normal saline in adults to prevent occlusion. SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search date was 20 October 2021. SELECTION CRITERIA We included randomised controlled trials in adults ≥ 18 years of age with a CVC that compared intermittent locking with heparin at any concentration versus normal saline. We excluded studies on infants and children from this review. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcomes were occlusion of CVCs and duration of catheter patency. Our secondary outcomes were CVC-related bloodstream infections and CVC-related colonisation, mortality, haemorrhage, heparin-induced thrombocytopaenia, CVC-related thrombosis, number of additional CVC insertions, abnormality of coagulation profile and allergic reactions to heparin. We used GRADE to assess the certainty of evidence for each outcome. MAIN RESULTS We identified one new RCT with 30 participants for this update. We included a total of 12 RCTs with 2422 participants. Data for meta-analysis were available from all RCTs. We noted differences in methods used by the included studies and variation in heparin concentrations (10 to 5000 IU/mL), time to follow-up (1 to 251.8 days), and the unit of analysis used (participant, catheter, line access). Five studies included ICU (intensive care unit) patients, two studies included oncology patients, and the remaining studies included miscellaneous patients (chronic kidney disease, haemodialysis, home care patients, etc.). Primary outcomes Overall, combined results may show fewer occlusions with heparin compared to normal saline but this is uncertain (risk ratio (RR) 0.70, 95% confidence interval (CI) 0.51 to 0.95; 10 studies; 1672 participants; low-certainty evidence). We pooled studies that used participant or catheter as the unit of analysis. We carried out subgroup analysis by unit of analysis. No clear differences were detected after testing for subgroup differences (P = 0.23). We found no clear evidence of a difference in the duration of catheter patency with heparin compared to normal saline (mean difference (MD) 0.44 days, 95% CI -0.10 to 0.99; 6 studies; 1788 participants; low-certainty evidence). Secondary outcomes We found no clear evidence of a difference in the following outcomes: CVC-related bloodstream infections (RR 0.66, 95% CI 0.08 to 5.80; 3 studies; 1127 participants; very low-certainty evidence); mortality (RR 0.76, 95% CI 0.44 to 1.31; 3 studies; 1100 participants; very low-certainty evidence); haemorrhage (RR 1.54, 95% CI 0.41 to 5.74; 3 studies; 1197 participants; very low-certainty evidence); or heparin-induced thrombocytopaenia (RR 0.21, 95% CI 0.01 to 4.27; 3 studies; 443 participants; very low-certainty evidence). The main reasons for downgrading the certainty of evidence for the primary and secondary outcomes were unclear allocation concealment, suspicion of publication bias, imprecision and inconsistency. AUTHORS' CONCLUSIONS Given the low-certainty evidence, we are uncertain whether intermittent locking with heparin results in fewer central venous catheter occlusions than intermittent locking with normal saline in adults. Low-certainty evidence suggests that heparin may have little or no effect on catheter patency duration. Although we found no evidence of differences in safety (CVC-related bloodstream infections, mortality, or haemorrhage), the combined studies were not powered to detect rare adverse events such as heparin-induced thrombocytopaenia. Further research conducted over longer periods would reduce the current uncertainties.
Collapse
Affiliation(s)
- Eduardo López-Briz
- Department of Pharmacy & CASP Spain, La Fe University Hospital, Valencia, Spain
| | - Vicente Ruiz Garcia
- Hospital at Home Unit & CASPe Spain, La Fe University Hospital, Valencia, Spain
| | - Juan B Cabello
- Department of Cardiology & CASP Spain, Hospital General Universitario de Alicante, Alicante, Spain
| | | | | |
Collapse
|
12
|
Santomauro I, Campani D, Tiozzo V, Barletta B, Scotti L, Barisone M, Dal Molin A. Heparin versus normal saline locking for prevention of occlusion, catheter-related infections and thrombosis in central venous catheter in adults: Overview of systematic reviews. J Vasc Access 2022:11297298221103201. [PMID: 35686498 DOI: 10.1177/11297298221103201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Venous access devices are used in health care. To prevent occlusions the evidence confirmed the need for routine catheter flushing before and after infusion as well as at the end of use. To date, the efficacy of heparin has not been demonstrated. The aim of this study was to evaluate the effectiveness of the locking of central venous catheters with heparin versus normal saline in adults to prevent occlusion, catheter-related infections and thrombosis in adults. A literature search using Medline, Embase, Cochrane Library and Cinahl was performed to identify all meta-analyses addressing the effectiveness of heparin versus normal saline in locking central venous catheters in adults. Four reviewers independently selected publications assessed quality and extracted data. Parameter estimates regarding occlusion, catheter- related infections and thrombosis were pooled using an umbrella review. We identified 6356 references. Seven systematic reviews were included in the study. Most of the studies included in the systematic reviews were conducted in oncohaematology departments, intensive care and cardiac surgery units among patients with multiple diseases and chronicity. Most studies report a heparin concentration of 10 to 5000 IU/ml versus normal saline and other solutions. There was no evidence that heparin was more effective than normal saline in reducing complications such as occlusion, catheter-related infections and thrombosis. No statistically significant difference was found between heparin and normal saline in reducing catheter occlusion. Heparin is not superior compared to normal saline.
Collapse
Affiliation(s)
- Isabella Santomauro
- Department of Translational Medicine, Università del Piemonte Orientale, Italy
| | - Daiana Campani
- Department of Translational Medicine, Università del Piemonte Orientale, Italy
| | - Valentina Tiozzo
- Department of Translational Medicine, Università del Piemonte Orientale, Italy
| | - Barbara Barletta
- Department of Translational Medicine, Università del Piemonte Orientale, Italy
| | - Lorenza Scotti
- Department of Translational Medicine, Università del Piemonte Orientale, Italy
| | - Michela Barisone
- Department of Translational Medicine, Università del Piemonte Orientale, Italy
| | - Alberto Dal Molin
- Department of Translational Medicine, Università del Piemonte Orientale, Italy
- Health Professions' Direction, Maggiore della Carità Hospital, Novara, Italy
| |
Collapse
|
13
|
Omatsu D, Thompson K, Maglasang B, Yuasa H, Kimata C. Heparin Versus Normal Saline: Flushing Effectiveness in Managing Central Venous Catheters in Pediatric Patients With Cancer. Clin J Oncol Nurs 2022; 26:300-307. [PMID: 35604736 DOI: 10.1188/22.cjon.300-307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND There is insufficient evidence of the effects of intermittent flushing with normal saline versus heparin to prevent occlusion or increased alteplase use in pediatric patients with central venous catheters. OBJECTIVES The primary objective was to evaluate the effectiveness of a new standard flushing practice in the management of central venous access devices in pediatric patients with cancer. A secondary objective was to assess the cost of heparin flushing supplies to patients and financial impact. METHODS New flushing guidelines included tunneled lines flushed with saline in the push-pause method twice daily in the inpatient setting. The outpatient setting required saline lock while receiving care and heparin lock on discharge. Alteplase usage was monitored for five months in all pediatric patients with cancer who had tunneled central lines. FINDINGS There was no statistically significant difference in alteplase usage rate pre- to postimplementation. A formal flushing guideline was recommended using saline and lower heparin concentrations for tunneled catheters.
Collapse
Affiliation(s)
- Dee Omatsu
- Kapi'olani Medical Center for Women and Children
| | | | | | - Hope Yuasa
- Kapi'olani Medical Center for Women and Children
| | | |
Collapse
|
14
|
Buzas B, Smith J, Gilbert GE, Moureau N. Home infusion pharmacy quality improvement for central venous access devices using anti-reflux needleless connectors to reduce occlusions, emergency room visits, and alteplase costs. Am J Health Syst Pharm 2022; 79:1079-1085. [PMID: 35323859 DOI: 10.1093/ajhp/zxac083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
DISCLAIMER In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE The study's purpose was to measure the impact of anti-reflux needleless connector usage in prevention of intraluminal thrombotic occlusions among central venous catheters, as represented by alteplase usage, in a home infusion patient population. METHODS An18-month before-and-after cohort study of a single home infusion intervention was conducted to compare occlusion outcomes with use of two types of needleless connectors-neutral and anti-reflux-in preventing catheter occlusions, which have been reported to occur in 28% of home infusion patients, resulting in treatment delays, increased nursing encounters and emergency room visits, and higher overall pharmacy costs for supplies and alteplase. RESULTS A total of 552,707 patient therapy days were studied: 42.5% in the neutral needleless connector group (n = 235,004 therapy days) and 57.5% in the anti-reflux needleless connector group (n = 317,703 therapy days). The rate of alteplase usage with neutral versus anti-reflux needleless connectors was 4.4% versus 2.2% per 1,000 therapy days, with median alteplase use of 112 (95% CI, 89-169) units versus 82 (95% CI, 68-109) units (P < 0.001). Implementation of anti-reflux connectors reduced occlusions and alteplase usage by 48%. CONCLUSION Statistical evidence demonstrated that use of anti-reflux needleless connectors with central venous access devices reduced the need for alteplase in the study population. Since 10% of patient occlusions were within 7 days after home infusion admission, future research may indicate that placement of anti-reflux needleless connectors at the time of in-hospital insertion can improve patient outcomes. This quality improvement measure reduced central catheter occlusions, alteplase costs, and the number of required nursing and emergency room visits.
Collapse
Affiliation(s)
- Bob Buzas
- Allegheny Health Network Home Infusion, Meadville, PA, USA
| | - Julie Smith
- Allegheny Health Network Home Infusion, Meadville, PA, USA
| | - Gregory E Gilbert
- SigmaStats Consulting, LLC, Charleston, SC, and ICON Commercialisation & Outcomes Services, North Wales, PA, USA
| | - Nancy Moureau
- PICC Excellence, Inc., Hartwell, GA, USA, and Alliance for Vascular Access Teaching and Research (AVATAR) Group, Griffith University, Brisbane, Australia
| |
Collapse
|
15
|
Ribeiro GDSR, Campos JF, Silva RCD. What do we know about flushing for intravenous catheter maintenance in hospitalized adults? Rev Bras Enferm 2022; 75:e20210418. [DOI: 10.1590/0034-7167-2021-0418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 09/28/2021] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: to evidence the use of flushing to prevent complications from intravenous therapy. Methods: an integrative review in databases, using descriptors and selection criteria. Data were collected in 12 articles using an instrument and later classified, summarized and aggregated for knowledge synthesis. Results: it was evident that: the pre-filled syringe resulted in a lower occurrence of catheter obstruction; irregular flushing frequency caused advanced phlebitis; the use of Venous Arterial Blood Management Protection (VAMP) generated a lower incidence of blood infection; heparinized solution did not result in a lower central catheter failure rate; flushing volume and frequency were not predictors of catheter failure; flushing practice was not shown to be incorporated among professionals. Conclusion: there are disagreements about the volume, frequency, solution and devices used in flushing. New technologies can reduce complications such as obstruction and infection.
Collapse
|
16
|
Chen JW, Hsu CC, Su CC, Hsu RB, Chiu YL, Chia JS, Jung CJ. Transient bacteremia promotes catheter-related central venous thrombosis through neutrophil extracellular traps. Thromb Haemost 2021; 122:1198-1208. [PMID: 34768303 DOI: 10.1055/a-1695-8612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Formation of intravenous catheter-related thrombosis leads to central venous stenosis in patients requiring renal replacement therapy or chemotherapy infusion, yet the triggering or mechanisms remain unclear, especially in patients without symptoms of infection. In this study, we found that neutrophil extracellular traps (NETs) could be detected in the fibrin sheaths from dialysis patients without clinical manifestations of infection. Confocal microscopy revealed bacteria imbedded in NETs in the fibrin sheaths. Thirty-nine of 50 (78%) fibrin sheath specimens contained bacteria detectable by 16S ribosomal RNA genome typing with a predominance of Staphylococcus aureus (69%). In rat models, transient bacteremia of S. aureus induced NETs in enlarged fibrin sheaths, and treatment with DNase I alone significantly reduced both NET and fibrin sheath formation surrounding the catheter. Therefore, transient bacteremia could be a silent trigger that induces NET-related immunothrombosis enhancing catheter-related central venous stenosis.
Collapse
Affiliation(s)
- Jeng-Wei Chen
- National Taiwan University Hospital, Department of Surgery, National Taiwan University College of Medicine, Taipei, Taiwan.,Graduate institute of clinical medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chih-Chieh Hsu
- School of Dentistry, Graduate Institute of Oral Biology, National Taiwan University, Taipei, Taiwan
| | - Chien-Chia Su
- National Taiwan University Hospital, Department of ophthalmology, National Taiwan University College of Medicine, Taipei, Taiwan.,Graduate institute of clinical medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ron-Bin Hsu
- National Taiwan University Hospital, Department of Surgery, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yen-Ling Chiu
- Graduate institute of clinical medicine, National Taiwan University College of Medicine, Taipei, Taiwan.,Department of Medicine, Division of Nephrology, Far Eastern Memorial Hospital, New Taipei City, Taiwan.,College of Informatics, Department of Computer Science and Engineering, Graduate Program in Biomedical Informatics, Yuan Ze University, Chung-Li, Taiwan
| | - Jean-San Chia
- Graduate institute of clinical medicine, National Taiwan University College of Medicine, Taipei, Taiwan.,Graduate Institute of Microbiology, National Taiwan University College of Medicine, Taipei, Taiwan.,School of Dentistry, Graduate Institute of Clinical Dentistry, National Taiwan University, Taipei, Taiwan
| | - Chiau-Jing Jung
- College of Medicine, School of Medicine, Department of Microbiology and Immunology, Taipei Medical University, Taipei, Taiwan
| |
Collapse
|
17
|
Sansalone A, Vicari R, Orlando F, Dell'Avo A, Giuffrida S, Deelen P, Bernasconi S, Villa M. Needle-free connectors to prevent central venous catheter occlusion at a tertiary cardiac center: A prospective before and after intervention study. J Vasc Access 2021; 24:475-482. [PMID: 34396802 DOI: 10.1177/11297298211039653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To evaluate the effectiveness of needle-free connectors to maintain Central Venous Catheter-CVC patency. BACKGROUND Loss of patency is a common complication associated with CVC. For patients, this can be stressful and painful, and can result in a delay in infusion therapy. Pressure-activated anti-reflux needle-free connectors are one of the most modern devices; however, no studies have compared this connector with the open-system three-way stopcock in terms of the incidence of CVC occlusion. METHODS This study is a prospective before and after intervention study. From March to August 2018, an observation phase was conducted with the three-way stopcock as the standard central venous catheter hub and closure system (phase 1). After implementation of needle-free connectors (phase 2), post-intervention observations were made from September 2019 to January 2020 (phase 3). RESULTS Of 199 CVCs analyzed, 41.2% (40/97) occluded in at least one lumen in the first phase, and 13.7% (14/102) occluded after introducing the technological device, absolute risk reduction 27.5% (95% confidence interval 15.6%-39.4%). The lumens supported by needle-free connectors showed a higher probability of maintaining patency compared with three-way stopcocks. No differences were observed in the rate of infection. CONCLUSIONS Pressure-activated anti-reflux needle-free connectors are effective and safe devices suitable for the management of vascular access in cardiac patient care. Staff training, even on apparently simple devices, is essential to avoid the risk of infection.
Collapse
Affiliation(s)
- Andrea Sansalone
- Department of Cardiology and Cardiac Surgery, Cardiocentro Ticino, Lugano, Switzerland
| | - Raffaello Vicari
- Department of Cardiology and Cardiac Surgery, Cardiocentro Ticino, Lugano, Switzerland
| | - Fabio Orlando
- Department of Cardiology and Cardiac Surgery, Cardiocentro Ticino, Lugano, Switzerland
| | - Alessandro Dell'Avo
- Department of Cardiology and Cardiac Surgery, Cardiocentro Ticino, Lugano, Switzerland
| | - Silvia Giuffrida
- Department of Cardiology and Cardiac Surgery, Cardiocentro Ticino, Lugano, Switzerland
| | - Paula Deelen
- Department of Cardiovascular Anesthesia and Intensive Care, Cardiocentro Ticino, Lugano, Switzerland
| | - Stefano Bernasconi
- Department of Cardiology and Cardiac Surgery, Cardiocentro Ticino, Lugano, Switzerland.,Department of Cardiovascular Anesthesia and Intensive Care, Cardiocentro Ticino, Lugano, Switzerland
| | - Michele Villa
- Department of Cardiovascular Anesthesia and Intensive Care, Cardiocentro Ticino, Lugano, Switzerland
| |
Collapse
|
18
|
Hosseini SJ, Eidy F, Kianmehr M, Firouzian AA, Hajiabadi F, Marhamati M, Firooz M. Comparing the Effects of Pulsatile and Continuous Flushing on Time and Type of Peripheral Intravenous Catheters Patency: A Randomized Clinical Trial. J Caring Sci 2021; 10:84-88. [PMID: 34222117 PMCID: PMC8242293 DOI: 10.34172/jcs.2021.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 07/27/2021] [Indexed: 11/09/2022] Open
Abstract
Introduction: Peripheral intravenous catheters (PICs) patency techniques such as flushing are being developed. According to some studies, flushing can be used continuously or in pulsatile forms. This study aimed to compare the effects of pulsatile flushing (PF) and continuous flushing (CF) on time and type of PICs patency. Methods: In this double-blind randomized clinical trial, 71 patients were randomly assigned into two groups of PF (n=35) and CF (n=36). The PF protocol was performed as successive injections of 1 mL normal saline (N/S) per second (sec) with a delay of less than 1 sec until the completion of 5 mL of solution. However, CF protocol was performed by injecting 5 mL N/S within 5 sec without any delay before and after each medicine administration. Data related to the time and type of PICs patency were collected using a patency checklist every 12 hours (h) up to 96 h. The statistical analysis was done by R statistical software (Version 3.5.1). Results: The results showed that the number of PICs remaining open was not significantly different between PF and CF groups during 96 h. The highest number of PICs excluded from the study was related to the time of 96 h as a result of partial patency in the two groups. Conclusion: There was no difference between CF and PF regarding the time and type of PICs patency. Thus, both techniques can be used to maintain the catheter patency.
Collapse
Affiliation(s)
| | - Fereshteh Eidy
- Department of Biostatistics, Esfarayen Faculty of Medical Sciences, Esfarayen, Iran
| | - Majid Kianmehr
- Department of Basic Sciences, Esfarayen Faculty of Medical Sciences, Esfarayen, Iran
| | | | - Fatemeh Hajiabadi
- Department of Medical Surgical, Faculty of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahmoud Marhamati
- Department of Nursing, Esfarayen Faculty of Medical Sciences, Esfarayen, Iran
| | - Mahbobeh Firooz
- Department of Nursing, Esfarayen Faculty of Medical Sciences, Esfarayen, Iran
| |
Collapse
|
19
|
Abstract
BACKGROUND To maintain implanted port patency, clinicians can better determine the difference between the use of heparin and normal saline, including risk to patients, unnecessary cost to the healthcare system, and whether heparin is effective in maintaining port patency. OBJECTIVES The aim is to compare the effectiveness of saline to heparin for maintaining implanted port patency and to evaluate the cost differences. METHODS Data were collected from 56 patients enrolled in oncology clinical trials; 37 had paired data. FINDINGS Results showed that saline was as effective as heparin in maintaining implanted port patency. The difference in mean cost of saline versus heparin was statistically significant. Eliminating heparin when locking implanted ports did not increase catheter occlusion rates.
Collapse
|
20
|
Wu XH, Chen LC, Liu GL, Zhang TT, Chen XS. Heparin versus 0.9% saline solution to maintain patency of totally implanted venous access ports in cancer patients: A systematic review and meta-analysis. Int J Nurs Pract 2021; 27:e12913. [PMID: 33484061 DOI: 10.1111/ijn.12913] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 12/07/2020] [Indexed: 02/05/2023]
Abstract
AIM The use of heparin and 0.9% saline solution is always controversial for central venous catheters. However, there is no systematic review or guideline about whether saline solution can replace heparin solution in adult cancer patients with totally implantable venous access ports (TIVAPs). The purpose of this review is to evaluate whether saline solution can replace heparin saline to lock TIVAPs. METHODS The following databases were searched: PubMed, the Cochrane Library, Web of Science, Embase, CINAHL and Ovid (January 1, 1982, and February 21, 2020). All statistical analyses of the meta-analysis were completed using the Review Manager 5.3. RESULTS A total of 201 studies were identified from these databases after initial review, and four studies met inclusion criteria, including 2652 cases. There was little heterogeneity among the included studies (I2 < 30%), and all analyses were conducted by the fixed-effects model. The total complications, catheter occlusions, catheter-related bloodstream infections and other complication rates in the heparin solution group were higher than in the saline solution group. In the subgroup analysis of heparin concentration, total complication rates in the saline solution group were higher than with 50 U of heparin and lower than with 100 U of heparin. However, the differences in these complications were small, and no significant difference was observed (all P > 0.05). CONCLUSIONS Based on existing clinical studies, we recommend that saline solution can replace 50 or 100 U/ml of heparin as a safe and effective flush solution for TIVAPs.
Collapse
Affiliation(s)
- Xiao-Hong Wu
- Department of Nursing, First Affiliated Hospital of Shantou University Medical College, Shantou, People's Republic of China
- Department of Nursing, Third People's Hospital of Chengdu, Chengdu, People's Republic of China
- School of Nursing, Shantou University Medical College, Shantou, People's Republic of China
| | - Li-Chan Chen
- School of Nursing, Shantou University Medical College, Shantou, People's Republic of China
| | - Gen-Li Liu
- Department of Nursing, Heilongjiang University of Chinese Medicine, Harbin, People's Republic of China
| | - Tian-Tian Zhang
- School of Nursing, Shantou University Medical College, Shantou, People's Republic of China
| | - Xi-Sui Chen
- Department of Nursing, First Affiliated Hospital of Shantou University Medical College, Shantou, People's Republic of China
| |
Collapse
|
21
|
Silva SRD, Reichembach MT, Pontes L, Souza GDPESCMD, Kusma S. Heparin solution in the prevention of occlusions in Hickman® catheters a randomized clinical trial. Rev Lat Am Enfermagem 2021; 29:e3385. [PMID: 33439945 PMCID: PMC7798395 DOI: 10.1590/1518-8345.3310.3385] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 07/03/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE to evaluate the effectiveness of the 50 IU/mL heparin solution compared to the 0.9% isotonic saline solution in preventing occlusion of the double lumen Hickman® catheter, 7 and 9 French, in patients undergoing hematopoietic stem cell transplantation. METHOD a triple-blind randomized clinical trial. 17 double-lumen catheters (heparin group: n=7 and 0.9% isotonic saline group: n=10) were analyzed in which the two catheter routes were evaluated separately, totaling 34 lumens. The outcome variables were occlusion without reflux and complete occlusion. Descriptive analyses were performed using the Chi-square test and, of survival, according to the Kaplan-Meier test. RESULTS the mean number of days until the occlusion outcome was 52 in the heparin group and 13.46 in the 0.9% isotonic saline group in the white catheter route (p<0.001). In the red route, the mean follow-up days in the heparin group were 35.29, with no occlusion and 22.30 in the 0.9% isotonic saline group until the first occlusion (p=0.030). CONCLUSION blocking with 50 IU/mL heparin solution is more effective than 0.9% isotonic saline in preventing occlusion of the Hickman® catheter. Brazilian Registry of Clinical Trials: RBR-3ht499.
Collapse
Affiliation(s)
| | | | | | | | - Solena Kusma
- Universidade Federal do Paraná, Departamento de Saúde Coletiva, Curitiba, PR, Brazil
| |
Collapse
|
22
|
Kanitra JJ, Power AD, Hayward RD, Haouilou JC, Edhayan E. Malfunctioning temporary hemodialysis catheters in patients with novel coronavirus disease 2019. J Vasc Surg 2020; 73:1881-1888.e3. [PMID: 33290813 PMCID: PMC7833410 DOI: 10.1016/j.jvs.2020.11.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 11/27/2020] [Indexed: 01/08/2023]
Abstract
Objective The hypercoagulability seen in patients with novel coronavirus disease 2019 (COVID-19) likely contributes to the high temporary hemodialysis catheter (THDC) malfunction rate. We aim to evaluate prophylactic measures and their association with THDC patency. Methods A retrospective chart review of our institutions COVID-19 positive patients who required placement of a THDC between February 1 to April 30, 2020, was performed. The association between heparin locking, increased dosing of venous thromboembolism (VTE) prophylaxis and systemic anticoagulation on THDC patency was assessed. Proportional hazards modeling was used to perform a survival analysis to estimate the likelihood and timing of THDC malfunction with the three different prophylactic measures. We also determined the mortality, rate of THDC malfunction and its association with d-dimer levels. Results A total of 48 patients with a mortality rate of 71% were identified. THDC malfunction occurred in 31.3% of patients. Thirty-seven patients (77.1%) received heparin locking, 22 (45.8%) received systemic anticoagulation, and 38 (79.1%) received VTE prophylaxis. Overall, the rate of THDC malfunction was lower at a trend level of significance, with heparin vs saline locking (24.3% vs 54.6%; P = .058). The likelihood of THDC malfunction in the heparin locked group is lower than all other groups (hazard ratio [HR], 0.07; 95% confidence interval [CI], 0.01-0.45]; P = .005). The rate of malfunction in patients with subcutaneous heparin (SQH) 7500 U three times daily is significantly lower than of the rate for patients receiving none (HR, 0.03; 95% CI, 0.001-0.74; P = .032). A trend level significant association was found for SQH 5000 U vs none (P = .417) and SQH 7500 vs 5000 U (P = .059). Systemic anticoagulation did not affect the THDC malfunction rate (P = .240). Higher d-dimer levels were related to greater mortality (HR, 3.28; 95% CI, 1.16-9.28; P = .025), but were not significantly associated with THDC malfunction (HR, 1.79; 95% CI, 0.42, 7.71; P = .434). Conclusions Locking THDCs with heparin is associated with a lower malfunction rate. Prospective randomized studies will be needed to confirm these findings to recommend locking THDC with heparin in patients with COVID-19. Increased VTE prophylaxis suggested a possible association with improved THDC patency, although the comparison lacked sufficient statistical power.
Collapse
Affiliation(s)
- John J Kanitra
- Department of Surgery, Ascension St. John Hospital, Detroit, Mich
| | | | - R David Hayward
- Department of Surgery, Ascension St. John Hospital, Detroit, Mich.
| | - Jimmy C Haouilou
- Department of Surgery, Ascension St. John Hospital, Detroit, Mich
| | - Elango Edhayan
- Department of Surgery, Ascension St. John Hospital, Detroit, Mich
| |
Collapse
|
23
|
Cellini M, Bergadano A, Crocoli A, Badino C, Carraro F, Sidro L, Botta D, Pancaldi A, Rossetti F, Pitta F, Cesaro S. Guidelines of the Italian Association of Pediatric Hematology and Oncology for the management of the central venous access devices in pediatric patients with onco-hematological disease. J Vasc Access 2020; 23:3-17. [PMID: 33169648 DOI: 10.1177/1129729820969309] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Central venous accesses devices (CVADs) have a fundamental importance for diagnostic and therapeutic purposes in pediatric onco-hematological patients. The treatment of pediatric onco-hematological diseases is complex and requires the use of integrated multimodal therapies. Long-lasting and safe central venous access is therefore a cornerstone for any successful treatment. METHODS The aim of this work is to define pediatric guidelines about the management of CVADs in onco-hematology. A panel of experts belonging to the working groups on Infections and Supportive Therapy, Surgery and Nursing of the Italian Pediatric Hematology Oncology Association (AIEOP) revised the scientific literature systematically, scored the level of evidence and prepared these guidelines. The content of the following guidelines was approved by the Scientific Board of AIEOP. RESULTS AND CONCLUSIONS Important innovations have been developed recently in the field of CVADs, leading to new insertion methods, new materials and new strategy in the overall management of the device, especially in the adult population. These guidelines recommend how to apply these innovations in the pediatric population, and are directed to all physicians, nurses and health personnel active in the daily management of CVADs. Their aim is to update the knowledge on CVAD and improve the standard of care in pediatric patients with malignancies.
Collapse
Affiliation(s)
- Monica Cellini
- Pediatric Hematology Oncology Unit, Azienda Ospedaliero Universitaria Policlinico di Modena, Modena, Emilia-Romagna, Italy
| | - Anna Bergadano
- Paediatric Onco-Haematology, Stem Cell Transplantation and Cellular Therapy Division, Regina Margherita Children's Hospital, Torino, Piemonte, Italy
| | - Alessandro Crocoli
- Surgical Oncology Unit, Department of Surgery, Bambino Gesù Children's Hospital, IRCSS, Rome, Italy
| | - Clara Badino
- Pediatric Hematology and Oncology Unit, Giannina Gaslini's Children Hospital, Genova, Liguria, Italy
| | - Francesca Carraro
- Paediatric Onco-Haematology, Stem Cell Transplantation and Cellular Therapy Division, Regina Margherita Children's Hospital, Torino, Piemonte, Italy
| | - Luca Sidro
- Anesthesiology and Intensive Care Unit, AORN Santobono Pausillipon, Napoli, Campania, Italy
| | - Debora Botta
- Pediatric Unit Ospedale Santissima Annunziata di Savigliano, Savigliano, Piemonte, Italy
| | - Alessia Pancaldi
- Post Graduate School of Pediatrics, Department of Medical and Surgical Sciences of the Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Francesca Rossetti
- Anesthesiology and Intensive Care Unit, Azienda Ospedaliero Universitaria Meyer, Firenze, Italy
| | - Federica Pitta
- Pediatric Hematology and Oncology Unit AORN Santobono Pausillipon, Napoli, Campania, Italy
| | - Simone Cesaro
- Pediatric Hematology and Oncology, Department of Mother and Child, Azienda Ospedaliera Universitaria Integrata, Verona, Veneto, Italy
| |
Collapse
|
24
|
Sasaki K, Paredes GP, Shiga T. Heparinized Saline Solution vs. Saline Solution (0.9% Sodium Chloride) for the Maintenance of Dorsal Pedal Arterial Catheter Patency in Dogs Undergoing General Anesthesia: A Pilot Study. Front Vet Sci 2020; 7:428. [PMID: 32851015 PMCID: PMC7402003 DOI: 10.3389/fvets.2020.00428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 06/15/2020] [Indexed: 11/24/2022] Open
Abstract
Heparin is widely used as an anticoagulant solution for maintaining arterial catheter patency. In humans, increasing evidence suggests that heparinized saline solution (HS) has no advantages over a saline (0.9% sodium chloride) solution (SS) in maintaining arterial catheter patency. To date, no studies have been conducted on the effectiveness of these solutions at maintaining arterial catheter patency in veterinary medicine. The objective of this pilot study was to determine the feasibility of a study and to report the treatment efficacy comparing HS and SS for the maintenance of the dorsal pedal arterial catheter patency during direct arterial blood pressure measurements in anesthetized dogs. Client-owned dogs undergoing abdominal surgery were allocated to two groups to receive either a continuous infusion of HS or SS through the dorsal pedal artery, and the arterial pressure waveform was monitored during general anesthesia. Our feasibility outcomes included the proportion of the screened veterinary patients that completed the study and the success rate of arterial catheter placement. The clinical outcomes were assessed by the number of catheter-flushing procedures, occlusion rate, the duration of the initial catheter-flushing procedures, and the duration of catheter occlusion. Of the 51 dogs screened, 41 (80.4%) completed the study. The success rate of arterial catheter placement in the HS and SS groups were 87.5 and 80.0%, respectively. There were no differences in the number of catheter-flushing procedures and occlusion rate between groups (28.6 vs. 20.0%, relative risk [RR]: 1.429, 95% confidence interval [CI]: 0.472–4.323, P = 0.719 and 14.3 vs. 15.0%, RR: 0.952, 95% CI: 0.217–4.179, P = 1.000, respectively). No differences were found in the probability of time to the initial catheter-flushing procedure and occlusion between groups assessed by the Kaplan-Meier method (P = 0.546 and P = 0.867, respectively). This study revealed the feasibility of a study comparing HS and SS for dorsal pedal arterial catheter patency during direct arterial blood pressure measurements in anesthetized dogs. Clinical outcome analyses were underpowered and thus, could not determine the meaningful differences in treatment efficacy between the groups. However, the information gained from this study provides insight for future study designs.
Collapse
Affiliation(s)
- Kazumasu Sasaki
- Small Animal Emergency and Critical Care Service, Sendai Animal Care and Research Center, Sendai, Japan.,Akita Cerebrospinal and Cardiovascular Center, Akita, Japan
| | - Gonzalo Polo Paredes
- UP Anesthésie-Analgésie-Réanimation, Département des Sciences Cliniques, Ecole Nationale Vétérinaire de Toulouse, Université Toulouse-Midi-Pyrénées, Toulouse, France
| | - Takuya Shiga
- Department of Anesthesiology and Perioperative Medicine, Tohoku University, Sendai, Japan
| |
Collapse
|
25
|
Zhou X, Lin X, Shen R, Qu Y, Mo C, Li Y, Chen Q, Wu G, Chen Z, Huang K. A retrospective analysis of risk factors associated with catheter-related thrombosis: a single-center study. Perfusion 2020; 35:806-813. [PMID: 32419612 DOI: 10.1177/0267659120915142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Catheter-related thrombosis may lead to catheter infections and failure, further deep venous thrombosis, and pulmonary embolism. Recognizing the risk factors for catheter-related thrombosis is extremely important to inform the development of catheter care guidelines. METHODS Data were collected from a total of 1,532 patients who had undergone venous catheterization, including indwelling catheterization from 19 March 2019 to 30 March 2019 in the Sun Yat-sen Memorial Hospital. The factors for which data were to be collected included the patients' physical characteristics, catheter-related factors, and catheter care-related factors. Logistic regression analysis, the chi-squared test, Fisher's exact test, and the t-test were used to analyze the data. RESULTS Of the 1,532 patients studied, 28 developed intraductal thrombi, and of the factors analyzed, malignancy, a catheterization history, a history of thrombophilia, surgery during the week before catheterization, the catheterization duration, and anticoagulant therapy were significant risk factors associated with catheter-related thrombosis (all p < 0.05). There were no significant associations between the catheter brand, the number of lumens, the insertion direction, or the factors associated with catheter care and catheter-related thrombosis (all p > 0.05). CONCLUSION Our study incorporated clear and systematic risk factors associated with catheter-related thrombosis. Malignancy, history of thrombophilia, history of catheterization, surgery during the week before catheterization, and catheterization duration were associated with increased risks of catheter-related thrombosis. Prophylactic anticoagulation was effective for preventing and treating catheter-related thrombosis.
Collapse
Affiliation(s)
- Xuezhen Zhou
- Department of Nursing, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xi Lin
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
| | - Runnan Shen
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
| | - Yingying Qu
- Venous Catheter Nursing Clinic, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Chunling Mo
- Venous Catheter Nursing Clinic, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yan Li
- Venous Catheter Nursing Clinic, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Qinchang Chen
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China.,The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Guitao Wu
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
| | - Zhenhong Chen
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
| | - Kai Huang
- Department of Cardiovascular Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| |
Collapse
|
26
|
Nursing Interventions to Reduce Peripherally Inserted Central Catheter Occlusion for Cancer Patients: A Systematic Review of Literature. Cancer Nurs 2020; 42:E49-E58. [PMID: 31658097 DOI: 10.1097/ncc.0000000000000664] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Cancer patients are considered the most at risk of the consequences of catheter occlusion. Therefore, nursing interventions that can effectively reduce the occlusion of peripherally inserted central catheter (PICC) lines must be identified to ensure a smooth treatment. OBJECTIVE This study aimed to evaluate nursing interventions to minimize PICC line occlusion and make recommended measures for preventing or decreasing occlusion and abnormal extubation. METHODS Studies about PICC occlusion that were published up to January 2017 were searched and screened in PubMed, Web of Science, Science Direct (Elsevier), EMBASE, Cochrane Library, and Chinese databases CNKI and Wanfang. Two independent reviewers screened the literature in accordance with the inclusion and exclusion criteria, assessed the quality of the included studies, and extracted the data. Further meta-analysis was performed using RevMan 5.3. RESULTS Thirteen trials were included. Meta-analysis revealed that education for nurses (relative risk, 0.31; 95% confidence interval, 0.19-0.51; P < .00001) was significantly associated with PICC occlusion, whereas PICC type (relative risk, 0.60; 95% confidence interval, 0.32-1.15; P = .12) was not significantly associated with PICC occlusion. The solution to washing pipes and the PICC insertion techniques were descriptively analyzed to reach statistical significance. CONCLUSION This study determined the correlation of PICC occlusion with the nurses' knowledge and skills, PICC types, flushing liquid and methods, and insertion techniques. IMPLICATIONS FOR PRACTICE The findings of this study can serve as a guide for clinical work and for developing targeted measures to reduce occlusion.
Collapse
|
27
|
Lok CE, Huber TS, Lee T, Shenoy S, Yevzlin AS, Abreo K, Allon M, Asif A, Astor BC, Glickman MH, Graham J, Moist LM, Rajan DK, Roberts C, Vachharajani TJ, Valentini RP. KDOQI Clinical Practice Guideline for Vascular Access: 2019 Update. Am J Kidney Dis 2020; 75:S1-S164. [PMID: 32778223 DOI: 10.1053/j.ajkd.2019.12.001] [Citation(s) in RCA: 925] [Impact Index Per Article: 231.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 12/09/2019] [Indexed: 02/07/2023]
Abstract
The National Kidney Foundation's Kidney Disease Outcomes Quality Initiative (KDOQI) has provided evidence-based guidelines for hemodialysis vascular access since 1996. Since the last update in 2006, there has been a great accumulation of new evidence and sophistication in the guidelines process. The 2019 update to the KDOQI Clinical Practice Guideline for Vascular Access is a comprehensive document intended to assist multidisciplinary practitioners care for chronic kidney disease patients and their vascular access. New topics include the end-stage kidney disease "Life-Plan" and related concepts, guidance on vascular access choice, new targets for arteriovenous access (fistulas and grafts) and central venous catheters, management of specific complications, and renewed approaches to some older topics. Appraisal of the quality of the evidence was independently conducted by using a Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach, and interpretation and application followed the GRADE Evidence to Decision frameworks. As applicable, each guideline statement is accompanied by rationale/background information, a detailed justification, monitoring and evaluation guidance, implementation considerations, special discussions, and recommendations for future research.
Collapse
|
28
|
Pérez-Granda MJ, Bouza E, Pinilla B, Cruces R, González A, Millán J, Guembe M. Randomized clinical trial analyzing maintenance of peripheral venous catheters in an internal medicine unit: Heparin vs. saline. PLoS One 2020; 15:e0226251. [PMID: 31905205 PMCID: PMC6944354 DOI: 10.1371/journal.pone.0226251] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 08/12/2019] [Indexed: 01/28/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- María Jesús Pérez-Granda
- Department of Clinical Microbiology and Infectious Diseases, H.G.U. Gregorio Marañón, Madrid, Spain
- Department of Nursing, School of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, Madrid, Spain
- CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain
- * E-mail: (MG); (MJP-G)
| | - Emilio Bouza
- CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain
- Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- Infection Study Group of the Sociedad Española de Medicina Interna, Madrid, Spain
| | - Blanca Pinilla
- Infection Study Group of the Sociedad Española de Medicina Interna, Madrid, Spain
- Department of Internal Medicine, H.G.U. Gregorio Marañón, Madrid, Spain
| | - Raquel Cruces
- Department of Clinical Microbiology and Infectious Diseases, H.G.U. Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Ariana González
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Jesús Millán
- Department of Internal Medicine, H.G.U. Gregorio Marañón, Madrid, Spain
| | - María Guembe
- Department of Clinical Microbiology and Infectious Diseases, H.G.U. Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- * E-mail: (MG); (MJP-G)
| |
Collapse
|
29
|
Honore PM, Gutierrez LB, Redant S, Kaefer K, Gallerani A, De Bels D. What should be the best dialysis catheter lock in critically ill patients? CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2019; 23:339. [PMID: 31666110 PMCID: PMC6822461 DOI: 10.1186/s13054-019-2640-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 10/09/2019] [Indexed: 01/14/2023]
Affiliation(s)
- Patrick M Honore
- ICU Department, Centre Hospitalier Universitaire Brugmann-Brugmann University Hpospital, Place Arthur Van Gehuchtenplein, 4, 1020, Brussels, Belgium.
| | - Leonel Barreto Gutierrez
- ICU Department, Centre Hospitalier Universitaire Brugmann-Brugmann University Hpospital, Place Arthur Van Gehuchtenplein, 4, 1020, Brussels, Belgium
| | - Sebastien Redant
- ICU Department, Centre Hospitalier Universitaire Brugmann-Brugmann University Hpospital, Place Arthur Van Gehuchtenplein, 4, 1020, Brussels, Belgium
| | - Keitiane Kaefer
- ICU Department, Centre Hospitalier Universitaire Brugmann-Brugmann University Hpospital, Place Arthur Van Gehuchtenplein, 4, 1020, Brussels, Belgium
| | - Andrea Gallerani
- ICU Department, Centre Hospitalier Universitaire Brugmann-Brugmann University Hpospital, Place Arthur Van Gehuchtenplein, 4, 1020, Brussels, Belgium
| | - David De Bels
- ICU Department, Centre Hospitalier Universitaire Brugmann-Brugmann University Hpospital, Place Arthur Van Gehuchtenplein, 4, 1020, Brussels, Belgium
| |
Collapse
|
30
|
Sharma SK, Mudgal SK, Gaur R, Sharma R, Sharma M, Thakur K. Heparin flush vs. normal saline flush to maintain the patency of central venous catheter among adult patients: A systematic review and meta-analysis. J Family Med Prim Care 2019; 8:2779-2792. [PMID: 31681643 PMCID: PMC6820433 DOI: 10.4103/jfmpc.jfmpc_669_19] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 08/22/2019] [Accepted: 09/09/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Around the globe, protocols for flushing the catheter to maintain the patency of central venous catheter (CVC) vary by institution to institution or by practitioner to practitioner. Therefore, this review was carried out with the aim of evaluating the efficacy of heparin flush vs. normal saline flush to maintain the patency of CVC among adult patients. METHODS We followed the guidelines of Cochrane handbook for interventions and searched in MEDLINE, Embase, Cochrane library, Clinical trials database, and reference list of related articles, which were published from Jan. 2012 to 31 Dec. 2018 in English language. We included only randomized controlled trials, and nine studies were included in this review. The pooled standard mean difference and relative risk were calculated by using Rev Man Review Manager 5. RESULTS We identified nine eligible studies with a total number of 3,113 participants. Consolidated results from eight studies conveyed little favorable effect to maintain patency of CVC with heparin when compared with normal saline as evident by risk ratio 0.83, 95% CI 0.50 - 1.40; P = 0.13. We also carried out analysis for secondary outcomes, and there was no evidence that heparin was better than normal saline in terms of safety except heparin-induced thrombocytopenia. CONCLUSIONS Heparin has little favorable effects to maintain patency of catheter than normal saline but not in secondary outcomes. As the quality of evidence was very low, therefore, results should be comprehend with care.
Collapse
Affiliation(s)
- Suresh K. Sharma
- Professor Cum Principal, Center of Excellence in Nursing Education and Research, AIIMS, Rishikesh, Uttarakhand, India
| | - Shiv K. Mudgal
- Nursing Tutor, Center of Excellence in Nursing Education and Research, AIIMS, Rishikesh, Uttarakhand, India
| | - Rakhi Gaur
- Nursing Tutor, Center of Excellence in Nursing Education and Research, AIIMS, Rishikesh, Uttarakhand, India
| | - Rakesh Sharma
- Assist. Professor, Center of Excellence in Nursing Education and Research, AIIMS, Rishikesh, Uttarakhand, India
| | - Maneesh Sharma
- Assist. Professor, Center of Excellence in Nursing Education and Research, AIIMS, Rishikesh, Uttarakhand, India
| | - Kalpana Thakur
- PhD Scholar, College of Nursing, Center of Excellence in Nursing Education and Research, AIIMS, Rishikesh, Uttarakhand, India
| |
Collapse
|
31
|
Vose J, Odunayo A, Price JM, Daves M, Schildt JC, Tolbert MK. Comparison of heparinized saline and 0.9% sodium chloride for maintaining central venous catheter patency in healthy dogs. PeerJ 2019; 7:e7072. [PMID: 31183263 PMCID: PMC6546076 DOI: 10.7717/peerj.7072] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 05/06/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The purpose of this study was to determine whether heparinized saline (HS) would be more effective in maintaining the patency of central venous catheters (CVCs) in dogs compared to 0.9% sodium chloride. This was a prospective randomized blinded study conducted at a University Veterinary Teaching Hospital. METHODS A total of 24 healthy purpose-bred dogs were randomized into two groups: a treatment and a control group. A CVC was placed in the jugular vein of each dog. Each dog in the treatment group had their CVC flushed with 10 IU/mL HS, while dogs in the control group had their CVC flushed with 0.9% sodium chloride every 6 h for 72 h. Immediately prior to flushing, each catheter was evaluated for patency by aspiration of blood. The catheter site was also evaluated for phlebitis, and a rectal temperature was obtained in each dog every 6 h. Prothrombin (PT) and activated partial thromboplastin (aPTT) times were evaluated prior to the administration of any flush solution. Results were then compared to values obtained 72 h later. RESULTS All CVCs in both groups were patent after 72 h, which was demonstrated by aspiration of blood and ease of flushing the catheter. Two CVCs in the 0.9% sodium chloride group had a negative aspiration at hour 12 and 36, respectively. One CVC in the HS group had a negative aspiration at hour 18. Signs of phlebitis occurred in three dog: two in the 0.9% sodium chloride group and one in the HS group. No dog was hyperthermic (>103 °F). Two catheters were inadvertently removed by dogs in the HS group during the study. There were no significant differences in catheter patency, incidence of phlebitis, or incidence of negative aspirations between both groups. aPTT and PT values remained within the normal reference range for all dogs in both groups. Ultimately, 0.9% sodium chloride was as effective as 10 IU/mL HS in maintaining the patency of CVCs for up to 72 h in healthy dogs. Further evaluation in clinical patients is warranted.
Collapse
Affiliation(s)
- Julieann Vose
- Department of Small Animal Clinical Sciences, University of Tennessee—Knoxville, Knoxville, TN, USA
| | - Adesola Odunayo
- Department of Small Animal Clinical Sciences, University of Tennessee—Knoxville, Knoxville, TN, USA
| | - Joshua M. Price
- Office of Information Technology, University of Tennessee—Knoxville, Knoxville, TN, USA
| | - Maggie Daves
- Department of Small Animal Clinical Sciences, University of Tennessee—Knoxville, Knoxville, TN, USA
| | - Julie C. Schildt
- Department of Small Animal Clinical Sciences, University of Tennessee—Knoxville, Knoxville, TN, USA
| | - M. Katherine Tolbert
- Department of Small Animal Clinical Sciences, Texas A&M University, College Station, TX, USA
| |
Collapse
|
32
|
A comparison of heparinised and non-heparinised normal saline solutions for maintaining the patency of arterial pressure measurement cannulae after heart surgery. J Cardiothorac Surg 2019; 14:39. [PMID: 30808385 PMCID: PMC6390345 DOI: 10.1186/s13019-019-0860-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 02/17/2019] [Indexed: 11/30/2022] Open
Abstract
Background Heparinized solution (HS) use for the maintenance of arterial cannulas has been associated with coagulation disorders and has not been conclusively shown to confer additional benefits over normal saline (NS) alone. We tested the hypothesis that in adult patients admitted to the cardiac ICU (T0) after cardiac surgery, HS arterial cannulas might be independently associated with increased heparin-induced coagulation disorders and might not be superior to NS arterial cannulas in reducing arterial cannula occlusion. Methods In this cohort study, 170 patients who received NS arterial cannulas during the period from T0 to ICU discharge were included in this study from June 1, 2017, to May 1, 2018 (NS group). There were 2930 patients who used HS (2.5 U/ml) arterial cannulas from January 1, 2015, to December 31, 2016 (heparin group). To address indicated biases, we derived a propensity score that predicted the functions of NS and HS in the patency of arterial cannulas. Results There were 296 patients (148 in the NS group and 148 in the heparin group) with similar risk profiles in the propensity-score matched cohorts. In the propensity-matched patients, the duration of arterial cannulas (P = 0.4) and arterial cannula occlusion (P = 0.5) showed no differences between the NS and heparin groups. However, the heparin group had a significantly increased activated clotting time (P < 0.05), activated partial thromboplastin time (P = 0.01) and allogeneic red blood cell utilization (3.4% vs 10.8%, P < 0.05). Compared with the NS group, the heparin group had more drainage from chest tubes from T0 to T48 (10.6 ± 9.4 ml/kg vs 13.0 ± 7.22 ml/kg, P < 0.05) and had more allogeneic red blood cells transfused (0.1 ± 0.4 U vs 0.4 ± 1.1 U, P < 0.05). Conclusion Based on the results of our study, the addition of heparin to normal saline for flushing arterial pressure monitoring cannulae did not reduce the incidence of catheter thrombosis and result in a very small but statically significant in increase in activated clotting time and activated partial thromboplastin time.
Collapse
|
33
|
López‐Briz E, Ruiz Garcia V, Cabello JB, Bort‐Martí S, Carbonell Sanchis R, Burls A. Heparin versus 0.9% sodium chloride locking for prevention of occlusion in central venous catheters in adults. Cochrane Database Syst Rev 2018; 7:CD008462. [PMID: 30058070 PMCID: PMC6513298 DOI: 10.1002/14651858.cd008462.pub3] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Intermittent locking of central venous catheters (CVCs) is undertaken to help maintain their patency. There are systematic variations in care: some practitioners use heparin (at different concentrations), whilst others use 0.9% NaCl (normal saline). This review looks at the effectiveness and safety of intermittent locking with heparin compared to 0.9% NaCl to see if the evidence establishes whether one is better than the other. This work is an update of a review first published in 2014. OBJECTIVES To assess the effectiveness and safety of intermittent locking of CVCs with heparin versus normal saline (NS) in adults to prevent occlusion. SEARCH METHODS The Cochrane Vascular Information Specialist (CIS) searched the Specialised Register (last searched 11 June 2018) and the Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 5). Searches were also carried out in MEDLINE, Embase, CINAHL, and clinical trials databases (11 June 2018). SELECTION CRITERIA We included randomised controlled trials in adults ≥ 18 years of age with a CVC that compared intermittent locking with heparin at any concentration versus NS. We applied no restriction on language. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials, assessed quality, and extracted data. We contacted trial authors to retrieve additional information, when necessary. We carried out statistical analysis using Review Manager 5 and assessed the overall quality of the evidence supporting assessed outcomes using GRADE. We carried out prespecified subgroup analysis. MAIN RESULTS We identified five new studies for this update (six prior studies were included in the original review), bringing the number of eligible studies to 11, with a total of 2392 participants. We noted differences in methods used by the included studies and variation in heparin concentrations (10 to 5000 IU/mL), time to follow-up (1 to 251.8 days), and the unit of analysis used (participant, catheter, line access).Combined results from these studies showed fewer occlusions with heparin than with NS (risk ratio (RR) 0.70, 95% confidence interval (CI) 0.51 to 0.95; P = 0.02; 1672 participants; 1025 catheters from 10 studies; I² = 14%) and provided very low-quality evidence.We carried out subgroup analysis by unit of analysis (testing for subgroup differences (P = 0.23; I² = 30.3%). When the unit of analysis was the participant, results show no clear differences in all occlusions between heparin and NS (RR 0.79, 95% CI 0.58 to 1.08; P = 0.15; 1672 participants; seven studies). Subgroup analysis using the catheter as the unit of analysis shows fewer occlusions with heparin use (RR 0.53, 95% CI 0.29 to 0.95; P = 0.03; 1025 catheters; three studies). When the unit of analysis was line access, results show no clear differences in occlusions between heparin and NS (RR 1.08, 95% CI 0.84 to 1.40; 770 line accesses; one study).We found no clear differences in the duration of catheter patency (mean difference (MD) 0.44 days, 95% CI -0.10 to 0.99; P = 0.11; 1036 participants; 752 catheters; six studies; low-quality evidence).We found no clear evidence of a difference in the following: CVC-related sepsis (RR 0.74, 95% CI 0.03 to 19.54; P = 0.86; 1097 participants; two studies; low-quality evidence); mortality (RR 0.76, 95% CI 0.44 to 1.31; P = 0.33; 1100 participants; three studies; low-quality evidence); haemorrhage at any site (RR 1.32, 95% CI 0.57 to 3.07; P = 0.52; 1245 participants; four studies; moderate-quality evidence); or heparin-induced thrombocytopaenia (RR 0.21, 95% CI 0.01 to 4.27; P = 0.31; 443 participants; three studies; low-quality evidence).The main reasons for downgrading the quality of evidence were unclear allocation concealment, imprecision, and suspicion of publication bias. AUTHORS' CONCLUSIONS Given the very low quality of the evidence, we are uncertain whether intermittent locking with heparin results in fewer occlusions than intermittent locking with NS. Low-quality evidence suggests that heparin may have little or no effect on catheter patency. Although we found no evidence of differences in safety (sepsis, mortality, or haemorrhage), the combined trials are not powered to detect rare adverse events such as heparin-induced thrombocytopaenia.
Collapse
Affiliation(s)
- Eduardo López‐Briz
- La Fe University HospitalDepartment of Pharmacy & CASP SpainAvda Fernando Abril Martorell 106ValenciaValenciaSpain46026
| | - Vicente Ruiz Garcia
- La Fe University HospitalHospital at Home Unit & CASPe SpainAv Fernando Abril Martorell nº 106ValenciaSpain46026
| | - Juan B Cabello
- Hospital General Universitario de AlicanteDepartment of Cardiology & CASP SpainPintor Baeza 12AlicanteAlicanteSpain03010
| | | | | | - Amanda Burls
- City University LondonSchool of Health SciencesMyddleton StreetLondonUKEC1V 0HB
| | | |
Collapse
|
34
|
A state of the art review on optimal practices to prevent, recognize, and manage complications associated with intravascular devices in the critically ill. Intensive Care Med 2018; 44:742-759. [PMID: 29754308 DOI: 10.1007/s00134-018-5212-y] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 05/05/2018] [Indexed: 12/14/2022]
Abstract
Intravascular catheters are inserted into almost all critically ill patients. This review provides up-to-date insight into available knowledge on epidemiology and diagnosis of complications of central vein and arterial catheters in ICU. It discusses the optimal therapy of catheter-related infections and thrombosis. Prevention of complications is a multidisciplinary task that combines both improvement of the process of care and introduction of new technologies. We emphasize the main component of the prevention strategies that should be used in critical care and propose areas of future investigation in this field.
Collapse
|
35
|
Lee KA, Ramaswamy RS. Intravascular access devices from an interventional radiology perspective: indications, implantation techniques, and optimizing patency. Transfusion 2018; 58 Suppl 1:549-557. [DOI: 10.1111/trf.14501] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Kristen A. Lee
- Dotter Interventional Institute, Oregon Health and Science University; Portland Oregon
| | - Raja S. Ramaswamy
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis; Missouri
| |
Collapse
|
36
|
Brito ARDO, Nishinari K, Saad PF, Saad KR, Pereira MAT, Emídio SCD, Yazbek G, Bomfim GAZ, Cavalcante RN, Krutman M, Teivelis MP, Pignataro BS, Fonseca IYI, Centofanti G, Soares BLF. Comparison between Saline Solution Containing Heparin versus Saline Solution in the Lock of Totally Implantable Catheters. Ann Vasc Surg 2017; 47:85-89. [PMID: 28947219 DOI: 10.1016/j.avsg.2017.09.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 08/29/2017] [Accepted: 09/07/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND There are only 3 studies comparing the efficacy of 2 different types of lock used in totally implantable catheters regarding occlusion or reflux dysfunction. The present study contains the largest published casuistry (862 patients) and is the only one that analyzes 3 parameters: occlusion, reflux dysfunction, and flow dysfunction. METHODS This was a retrospective study of patients operated at a large oncology center and followed up in the outpatient clinic between 2007 and 2015. The patients were divided into 2 groups according to the type of lock: the Hep group (heparine), whose lock was composed of saline solution 0.9% with heparin (100 IU/mL) and the SS group (saline solution), whose lock was composed of saline solution 0.9%. RESULTS The Hep group was composed of 270 patients (31%) and the SS group of 592 patients (69%). Regarding occlusion, there were 8 cases in the Hep group (2.96%) and 8 in the SS group (1.35%; P = 0.11); in relation to reflux dysfunction, there were 8 cases in the Hep group (2.96%) and 8 in the SS group (1.35%; P = 0.11); in relation to flow dysfunction, there was 1 case in the Hep group (0.37%) and 4 cases in the SS group (0.68%; P = 1). CONCLUSIONS There was no statistically significant difference between the groups regarding occlusion, reflux dysfunction, and flow dysfunction.
Collapse
Affiliation(s)
| | - Kenji Nishinari
- Department of Vascular and Endovascular Surgery, AC Camargo Cancer Center, São Paulo, São Paulo, Brazil
| | | | | | | | | | - Guilherme Yazbek
- Department of Vascular and Endovascular Surgery, AC Camargo Cancer Center, São Paulo, São Paulo, Brazil
| | | | - Rafael Noronha Cavalcante
- Department of Vascular and Endovascular Surgery, AC Camargo Cancer Center, São Paulo, São Paulo, Brazil
| | - Mariana Krutman
- Department of Vascular and Endovascular Surgery, AC Camargo Cancer Center, São Paulo, São Paulo, Brazil
| | - Marcelo Passos Teivelis
- Department of Vascular and Endovascular Surgery, AC Camargo Cancer Center, São Paulo, São Paulo, Brazil
| | - Bruno Soriano Pignataro
- Department of Vascular and Endovascular Surgery, AC Camargo Cancer Center, São Paulo, São Paulo, Brazil
| | | | - Guilherme Centofanti
- Department of Vascular and Endovascular Surgery, AC Camargo Cancer Center, São Paulo, São Paulo, Brazil
| | | |
Collapse
|