title: Surface heparinization of central venous catheters reduces microbial colonization in vitro and in vivo: results from a prospective, randomized trial.
abstract: OBJECTIVE
  To evaluate in vitro and in vivo the efficacy of covalent end point-attached heparin to single-lumen polyurethane central venous catheters in reducing microbial adherence and colonization.
  
  
  METHODS
  In vitro study: A controlled bench study. In vivo study: A prospective, randomized, double-blind, clinical trial.
  
  
  METHODS
  Intensive care unit in a 1200-bed teaching hospital.
  
  
  METHODS
  In vitro study: Adhesion of 17 radiolabeled clinical isolates of Staphylococci to catheters was examined in vitro. In vivo study: The outcome of heparinized and control catheters was compared in vivo in patients receiving long-term parenteral nutrition. Fifty-five adult patients were prospectively, blindly randomized to heparinized or control central venous catheters. The catheters, removed on clinical grounds, were analyzed with semiquantitative and quantitative cultures. Blood cultures were done at catheter removal.
  
  
  RESULTS
  In vitro study: Coagulase-negative Staphylococci adhered less in vitro to heparinized catheters than to control catheters (p < .05). In vivo study: Among 32 central venous catheters, or patients who completed the study, catheter-associated bacteremia or fungemia was observed in five patients in the control group (n = 19) and in no patient with a heparinized catheter (n = 13) (p = .047). Four of 13 catheters in the heparin group were colonized compared with 14 of 19 in the control group (p = .03). Coagulase-negative Staphylococci were the most frequent microorganisms in both groups. The numbers of organisms found on colonized catheters were larger in the control group than in the heparin group.
  
  
  CONCLUSIONS
  Covalent end point surface heparinization appears to have a great impact on both in vitro and in vivo bacterial colonization of central venous catheters. Such heparinization can be a practical and economical approach to the prevention of catheter-associated bacteremia or fungemia.
authors.affiliation: Department of Internal Medicine, Karolinska Hospital, Stockholm, Sweden.
authors.forename: P
authors.initials: P
authors.lastname: Appelgren
authors.forename: U
authors.initials: U
authors.lastname: Ransjö
authors.forename: L
authors.initials: L
authors.lastname: Bindslev
authors.forename: F
authors.initials: F
authors.lastname: Espersen
authors.forename: O
authors.initials: O
authors.lastname: Larm
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000517:prevention & control*; D001422:Bacterial Adhesion / Q000187:drug effects*; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002408:Catheters, Indwelling / Q000382:microbiology*; D003428:Cross Infection / Q000517:prevention & control; D004311:Double-Blind Method; D004866:Equipment Contamination / Q000517:prevention & control*; D005260:Female; D006493:Heparin / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013210:Staphylococcus / Q000302:isolation & purification
chemical_list: D006493:Heparin