A randomized, controlled trial of heparin versus placebo infusion to prolong the usability of peripherally placed percutaneous central venous catheters (PCVCs) in neonates: the HIP (Heparin Infusion for PCVC) study.
BACKGROUND
Mechanical and infectious complications shorten the effective duration of peripherally inserted central venous catheters. Heparin use to prevent such complications and prolong the usability of peripherally inserted central venous catheters is inconclusive.


OBJECTIVE
Our goal was to evaluate the effectiveness of heparin in prolonging the usability of peripherally inserted central venous catheters in neonates.


METHODS
We performed a multicenter, randomized, controlled trial of heparin infusion (0.5 U/kg per hour) versus placebo for peripherally inserted central venous catheters in neonates. The primary outcome was duration of catheter use. Secondary outcomes were occlusion, catheter-related sepsis, thrombosis, and adverse effects of heparin. To detect a 168-hour (1-week) difference in the duration of catheter use, 192 patients were needed. Kaplan-Meier and Cox regression analyses were performed.


RESULTS
A total of 201 neonates were enrolled (heparin group: n = 100; control group: n = 101). Baseline demographics were similar between the groups. Duration of catheter use was longer in the infants in the heparin versus the placebo group. Study center, gender, birth weight, and type and position of the catheter were not predictors of duration of catheter use. For those in the heparin versus the placebo group, the incidence of elective catheter removal (therapy completed) was 63% vs 42%, of occlusion was 6% vs 31%, of thrombosis was 20% vs 21%, and of catheter-related sepsis was 10% vs 6%, respectively. No adverse events were noted.


CONCLUSIONS
Heparin infusion prolonged the duration of peripherally inserted central venous catheter usability, which permitted a higher percentage of neonates to complete therapy without increasing adverse effects.
Shah
Prakesh S
PS
Department of Pediatrics, Mount Sinai Hospital, 775A, 600 University Ave, Toronto, Ontario, Canada M5G 1X5. pshah@mtsinai.on.ca
Kalyn
Angela
A
Satodia
Prakash
P
Dunn
Michael S
MS
Parvez
Boriana
B
Daneman
Alan
A
Salem
Shia
S
Glanc
Phyllis
P
Ohlsson
Arne
A
Shah
Vibhuti
V
D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000379:methods; D002406:Catheterization, Peripheral; D020878:Device Removal; D004311:Double-Blind Method; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced; D006493:Heparin / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007262:Infusions, Intravenous; D008297:Male; D016016:Proportional Hazards Models; D018805:Sepsis / Q000209:etiology; D016019:Survival Analysis; D013921:Thrombocytopenia / Q000139:chemically induced; D013927:Thrombosis / Q000517:prevention & control
D000925:Anticoagulants; D006493:Heparin