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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.
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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
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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.
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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
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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.
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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.
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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
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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.
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de Oliveira FJG, Rodrigues AB, Ramos IC, Caetano JÁ. Dosage of heparin for patency of the totally implanted central venous catheter in cancer patients. Rev Lat Am Enfermagem 2020; 28:e3304. [PMID: 32578754 PMCID: PMC7304977 DOI: 10.1590/1518-8345.3326.3304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 03/07/2020] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE to analyze the evidence available in the literature about the lowest necessary dose of heparin to maintain the patency of the totally implanted central venous catheter in adult cancer patients. METHOD an integrative literature review, carried out in the following databases: Literatura Latino-Americana e do Caribe em Ciências de Saúde, Sciverse Scopus, Web of Science, Cumulative Index to Nursing and Allied Health Literature, Cochrane Central Register of Controlled Trials, including thirteen studies. RESULTS the evidence showed that the dose of heparin (300 IU/ml) is the most used in maintaining the patency of the totally implanted central venous catheter. CONCLUSION according to the selected studies, the lowest dose of heparin found in maintaining the patency of the totally implanted central venous catheter in cancer patients was 10 UN/ml with a volume of 5 ml of the heparin solution.
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Affiliation(s)
- Francisca Jane Gomes de Oliveira
- Universidade Federal do Ceará, Fortaleza, CE, Brazil
- Hospital Monte Klinikum, Unidade de Terapia Intensiva, Fortaleza,
CE, Brazil
| | | | - Islane Costa Ramos
- Universidade Federal do Ceará, Departamento de Enfermagem,
Fortaleza, CE, Brazil
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Bradford NK, Edwards RM, Chan RJ. Normal saline (0.9% sodium chloride) versus heparin intermittent flushing for the prevention of occlusion in long-term central venous catheters in infants and children. Cochrane Database Syst Rev 2020; 4:CD010996. [PMID: 32352563 PMCID: PMC7192095 DOI: 10.1002/14651858.cd010996.pub3] [Citation(s) in RCA: 6] [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: 01/09/2023]
Abstract
BACKGROUND Guidelines and clinical practice for the prevention of complications associated with central venous catheters (CVC) around the world vary greatly. Most institutions recommend the use of heparin to prevent occlusion; there is debate, however, regarding the need for heparin and evidence to suggest normal saline (0.9% sodium chloride) may be as effective. The use of heparin is not without risk, may be unnecessary and is also associated with increased cost. This is an update of the review published in 2015. OBJECTIVES To assess the clinical effects (benefits and harms) of intermittent flushing of normal saline versus heparin to prevent occlusion in long-term central venous catheters in infants and children. SEARCH METHODS The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase and CINAHL databases; World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials register to 9 April 2019. We also undertook reference checking, citation searching and contact with study authors to identify additional studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) that compared the efficacy of intermittent flushing with normal saline versus heparin to prevent occlusion of long-term CVCs in infants and children aged up to 18 years of age. We excluded temporary CVCs and peripherally inserted central catheters (PICC). DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial inclusion criteria, trial quality and extracted data. We assessed study quality with the Cochrane 'Risk of bias' tool. For dichotomous outcomes, we calculated the rate ratio (RR) and corresponding 95% confidence interval (CI). We pooled data using a random-effects model; and we used GRADE to assess the overall certainty of the evidence supporting the outcomes assessed in this review. MAIN RESULTS We identified one new study for this update, bringing the total number of included studies to four (255 participants). The four trials directly compared the use of normal saline and heparin; the studies all used different protocols for the intervention and control arms, however, and all used different concentrations of heparin. Different frequencies of flushes were also reported between studies. In addition, not all studies reported on all outcomes. The certainty of the evidence ranged from moderate to very low because there was no blinding; heterogeneity and inconsistency between studies was high; and the CIs were wide. CVC occlusion was assessed in all four trials. We were able to pool the results of two trials for the outcomes of CVC occlusion and CVC-associated blood stream infection. The estimated RR for CVC occlusion per 1000 catheter days between the normal saline and heparin groups was 0.75 (95% CI 0.10 to 5.51; 2 studies, 229 participants; very low certainty evidence). The estimated RR for CVC-associated blood stream infection was 1.48 (95% CI 0.24 to 9.37; 2 studies, 231 participants; low-certainty evidence). The duration of catheter placement was reported to be similar for the two study arms in one study (203 participants; moderate-certainty evidence), and not reported in the remaining studies. AUTHORS' CONCLUSIONS The review found that there was not enough evidence to determine the effects of intermittent flushing with normal saline versus heparin to prevent occlusion in long-term central venous catheters in infants and children. It remains unclear whether heparin is necessary to prevent occlusion, CVC-associated blood stream infection or effects duration of catheter placement. Lack of agreement between institutions around the world regarding the appropriate care and maintenance of these devices remains.
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Affiliation(s)
- Natalie K Bradford
- Centre for Children's Health Research, Institute of Health and Biomedical Innovation, Queensland University of Technology (QUT), South Brisbane, Australia
| | - Rachel M Edwards
- Oncology Services Group, Queensland Children's Hospital, South Brisbane, Australia
| | - Raymond J Chan
- School of Nursing, Queensland University of Technology, Brisbane, Australia
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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.
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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
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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.
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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
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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.
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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
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