Maintenance of the patency of indwelling central venous catheters: is heparin necessary?
Related Experiment Videos
S Smith1, S Dawson, R Hennessey
1Hematology-Oncology Service, Children's Hospital at Chedoke-McMaster, Hamilton, Ontario, Canada.
Insights
Maintaining central venous catheter patency in pediatric cancer patients can be achieved with weekly saline flushes, similar to daily heparin flushes. This study found no significant difference in catheter blockage or complications between the two methods.
Area of Science:
- Pediatric Oncology
- Vascular Access Devices
- Clinical Nursing
Background:
- Indwelling central venous catheters are crucial for ambulatory pediatric cancer care.
- Maintaining catheter patency is essential but current methods present challenges.
- The standard heparin flush protocol is costly and inconvenient for families.
Purpose of the Study:
- To compare the efficacy of a weekly isotonic saline flush versus a twice-daily heparin flush for maintaining central venous catheter patency.
- To evaluate complications such as blockage, thrombus formation, and infection associated with each flushing method.
Main Methods:
- A randomized cross-over study design was employed.
- The study compared a standard twice-daily heparin flush with an experimental weekly isotonic saline flush.
- Catheter patency, blockage, thrombus, and infection were monitored over approximately 1,515 days per arm.
Main Results:
- One catheter blockage occurred in the experimental arm.
- Two episodes of thrombus formation were observed, one in each study arm.
- Infection incidence was higher in the experimental arm, prompting further investigation.
Conclusions:
- Weekly isotonic saline flushes are as effective as daily heparin flushes in preventing catheter blockage and thrombus formation.
- While infection rates were higher with the experimental method, overall complication rates were not significantly different.
- The findings suggest a less intensive flushing regimen may be a viable alternative for pediatric cancer patients with central venous catheters.
Abstract:
The use of indwelling central venous catheters for the ambulatory management of children with cancer has been well described. There remains uncertainty as to the best method for maintaining the patency of these catheters. The standard approach at our institution is to flush the catheter twice daily with a solution containing heparin. This is both costly and inconvenient for most families. We describe a randomized cross-over study designed to compare the standard approach to a less intense program using an isotonic saline flush once a week. Evaluation continued for approximately 1,515 days in each study arm. The catheters were monitored for blockage, clot formation, and infection. One catheter blocked in a patient receiving the experimental method of care. Two episodes of thrombus formation were demonstrated at the end of the study (one in each of the study arms). The incidence of infection, while in keeping with our overall experience, was higher in the experimental arm. This led to a subsequent study, reported separately in this symposium. The results indicate that there is no significant difference, in the incidence of blocked catheters or other complications, between the two forms of care.