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Yeung F, Miller MR, Ojha R, McKelvie B, Poonai N, Bock DE, Cameron S, Taheri S. Saline-Lock Versus Continuous Infusion: Maintaining Peripheral Intravenous Catheter Access in Children. Hosp Pediatr 2020; 10:1038-1043. [PMID: 33172866 DOI: 10.1542/hpeds.2020-0137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES In children, peripheral intravenous catheters (PIVs) are maintained by either a continuous infusion of fluid "to keep vein open" (TKO) or a saline lock (SL). There is a widespread perception that TKO prolongs PIV patency, but there is a lack of evidence for this. We hypothesized that there would be no significant difference in duration of PIV patency between TKO and SL. PATIENTS AND METHODS This prospective, time-allocated study included patients from newborn to 17 years of age admitted to our pediatric ward. Patients enrolled in the first 3 months were assigned to TKO, and patients in the latter 3 months were assigned to SL. Primary outcome was duration of functional patency of the first PIV during the time of TKO or SL. Secondary outcomes included PIV-related complications and patient and caregiver satisfaction. RESULTS Complete PIV data were available on 172 (n = 85 TKO, n = 87 SL) of 194 enrolled patients. The mean (SD) duration of PIV patency was 41.68 (41.71) hours in the TKO group and 44.05 (41.46) hours in the SL group, which was not significantly different (P = .71). There were no significant differences in complication rates or overall patient and caregiver satisfaction. One patient in the TKO group had their PIV removed because of risk of strangulation from tubing. CONCLUSION There were no significant differences between TKO and SL in the duration of PIV patency, complication rates, and overall patient and caregiver satisfaction in our pediatric population. Overall, SL is a safe and reasonable alternative to TKO in maintaining PIV patency in children.
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Affiliation(s)
- Frances Yeung
- Department of Pediatrics, Children's Hospital, London Health Sciences Centre, London, Ontario.,Division of General Academic Pediatrics, Department of Pediatrics, Western University, London, Ontario; and
| | - Michael R Miller
- Department of Pediatrics, Children's Hospital, London Health Sciences Centre, London, Ontario.,Children's Health Research Institute, London, Ontario.,Lawson Health Research Institute, London, Ontario.,Division of General Academic Pediatrics, Department of Pediatrics, Western University, London, Ontario; and
| | - Rahul Ojha
- Department of Pediatrics, Children's Hospital, London Health Sciences Centre, London, Ontario.,Children's Health Research Institute, London, Ontario
| | - Brianna McKelvie
- Department of Pediatrics, Children's Hospital, London Health Sciences Centre, London, Ontario.,Children's Health Research Institute, London, Ontario
| | - Naveen Poonai
- Department of Pediatrics, Children's Hospital, London Health Sciences Centre, London, Ontario.,Children's Health Research Institute, London, Ontario.,Lawson Health Research Institute, London, Ontario.,Division of General Academic Pediatrics, Department of Pediatrics, Western University, London, Ontario; and.,Department of Pediatrics, Children's Hospital, London Health Sciences Centre, London, Ontario.,Internal Medicine, and.,Epidemiology and Biostatistics, London Health Sciences Centre, London, Ontario
| | - Dirk E Bock
- Department of Pediatrics, Children's Hospital, London Health Sciences Centre, London, Ontario.,Children's Health Research Institute, London, Ontario.,Division of General Academic Pediatrics, Department of Pediatrics, Western University, London, Ontario; and
| | - Saoirse Cameron
- Department of Pediatrics, Children's Hospital, London Health Sciences Centre, London, Ontario
| | - Sepideh Taheri
- Department of Pediatrics, Children's Hospital, London Health Sciences Centre, London, Ontario; .,Children's Health Research Institute, London, Ontario.,Lawson Health Research Institute, London, Ontario.,Division of General Academic Pediatrics, Department of Pediatrics, Western University, London, Ontario; and
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Sotnikova C, Fasoi G, Efstathiou F, Kaba E, Bourazani M, Kelesi M. The Efficacy of Normal Saline (N/S 0.9%) Versus Heparin Solution in Maintaining Patency of Peripheral Venous Catheter and Avoiding Complications: a Systematic Review. Mater Sociomed 2020; 32:29-34. [PMID: 32410888 PMCID: PMC7219714 DOI: 10.5455/msm.2020.32.29-34] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 03/06/2020] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Heparin is a sulfated polysaccharide belonging to the glycosaminoglycan family with strong anticoagulant activity. It has been widely used to maintain intravascular catheters in patients requiring intravenous medication. It is believed that heparin prevents thrombus formation in the intravascular catheter, but since the 1980s, the necessity of the heparin solution for peripheral intravenous catheter (PIVC) flushing has been questioned in several clinical trials. According to the Institute for Safe Medication Practices (ISMP), there are four special categories of High Alert Medications (HAMs), including heparin. AIM The aim of this systematic review was to investigate the efficacy of normal saline versus heparin solution in maintaining the patency and functionality of the PIVC and avoiding complications. METHODOLOGY A systematic review using PubMed and Cochrane Library databases was conducted. Original research studies of hospitalized patients with PIVC, regardless of age, published in English, over the last decade (2009-2019) were eligible for inclusion. RESULTS The review concluded in 10 studies that met the inclusion criteria. From these studies, it appears that it is not fully documented whether the normal saline (N/S 0,9%) is superior to heparin solution (H/S) in the flushing of the PIVC for maintaining its patency and prevent complications. Researchers tend to support the use of N/S 0,9% due to safety, error avoidance, efficiency, ease of use and cost-effectiveness. Concern about the possible complications of the heparin solution was the cause of guidelines development for N/S 0,9% in countries such as Australia. CONCLUSIONS The use of normal saline seems to outweigh the heparin solution in maintaining the patency of PIVC.
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Affiliation(s)
| | - Georgia Fasoi
- Department of Nursing, University of West Attica, Athens, Greece
| | | | - Evridiki Kaba
- Department of Nursing, University of West Attica, Athens, Greece
| | - Maria Bourazani
- Department of Anesthesiology, Hellenic Anticancer Institute, Saint Savvas Hospital, Athens, Athens, Greece
| | - Martha Kelesi
- Department of Nursing, University of West Attica, Athens, Greece
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Gunes A, Bramhagen AC. Heparin or Sodium Chloride for Prolonging Peripheral Intravenous Catheter Use in Children - A Systematic Review. J Pediatr Nurs 2018; 43:e92-e99. [PMID: 30098834 DOI: 10.1016/j.pedn.2018.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 07/31/2018] [Accepted: 08/02/2018] [Indexed: 01/06/2023]
Abstract
PROBLEM Children's wellbeing should always be considered but during hospital stay, many children experience pain due to medical procedures such as inserting a peripheral venous catheter. In order to prolong the time in situ and to avoid the necessity to change the catheter frequently, it can be flushed with either heparin or sodium chloride. Since heparin has negative side effects, the aim of this study was to examine whether or not there is any scientific support for intermittent flush with heparin being more efficient in extending the time in situ as compared to intermittent flush with sodium chloride. ELIGIBILITY CRITERIA A systematic review structured according to PICO was performed. The databases used were PubMed, CINAHL and Cochrane Library, and eligible study designs were systematic reviews and randomized controlled double-blinded trials. The studies were critically appraised and synthesized, after which an evidence grading was performed. SAMPLE Two systematic reviews and four randomized controlled double-blinded trials were included. RESULTS The systematic reviews were assessed as high quality and the randomized controlled double-blinded trials assessed as moderate quality. The results showed both significant differences, and no significant differences between heparin groups and sodium chloride groups regarding time in situ. CONCLUSIONS Our conclusion is that heparin might not be necessary but no guidelines are possible to develop. IMPLICATIONS Since heparin has negative side effects among children and no significant result in favor of heparin was found, more studies are needed in order to provide evidence-based care.
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Affiliation(s)
- Aynur Gunes
- Department of Paediatrics, Skåne University Hospital, Malmö, Sweden
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