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The effects of heparin flush on patency of the Groshong catheter: a pilot study
D J Mayo1, M K Horne, B L Summers
1Warren Grant Magnuson Clinical Center of the National Institutes of Health in Bethesda, MD, USA.
Purpose/Objectives:
To determine whether the addition or a heparinized saline flush would decrease clot formation and persistent withdrawal occlusion (PWO) in Groshong (Bard Access Systems, Salt Lake City, UT) catheters.
Design:
A prospective, nonrandomized study using a historical control group of patients with Groshong catheters that had been flushed weekly with 5 ml normal saline compared to data from patients with Groshong catheters flushed weekly with 2.5 ml heparinized saline (100 U/ml). A retrospective chart review was performed to determine the incidence of PWO. In both groups, the presence of liquid blood and adherent or nonadherent clot in explanted catheters was recorded.
Setting:
Oncology inpatient and outpatient units of a cancer research center located in a mid-Atlantic city in the United States.
Control Group:
Twenty-eight 9.5 Fr. double-lumen Groshong catheters maintained with a saline flush. Experimental group: Twenty-three double-lumen Groshong catheters maintained with a heparin flush. At the time of this report, 12 of these 23 catheters had been explanted and 11 remained in place.
Methods:
The frequency of PWO was measured in a retrospective chart review and determined by the number of urokinase instillations required for each catheter. All 28 catheters in the saline flush group and 8 catheters in the heparin flush group were examined immediately after removal for intraluminal liquid blood and adherent or nonadherent clot.
Main Research Variables:
Urokinase usage, intra-luminal blood or clot, and PWO.
Findings:
PWO occurred less frequently in the heparin flush group (p = 0.006) than in the saline fush group. All 28 of the saline flush catheters developed an adherent clot in one or both lumens, whereas no adherent clots were found in the heparin flush catheters (p < 0.0001).
Conclusions:
The addition of a heparinized saline weekly flush to maintain Groshong catheters decreased the presence of intraluminal adherent clots and improved the catheter function.
Implications For Nursing Practice:
The safe delivery of medication and the ability to obtain blood specimens are vital for patients who depend on functioning venous access catheters. Flushing Groshong catheters with heparinized saline decreases the likelihood of intraluminal clot formation and catheter malfunction.