title: Prospective, randomized trial of two different modalities of flushing central venous catheters in pediatric patients with cancer.
abstract: OBJECTIVE
  There are limited prospective data on whether the method of flushing affects the complication rate of tunnelled central venous catheters (CVCs).
  
  
  METHODS
  During a 25-month period, 203 pediatric patients who had newly placed Broviac-Hickman CVCs were randomly assigned to standard flushing with heparin solution or to experimental flushing with normal saline via a positive-pressure cap.
  
  
  RESULTS
  Two hundred twenty-one complications were recorded among 75,249 CVC-days (2.94 per 1,000 CVC-days). A higher incidence of CVC occlusion (83 v 41 episodes; P = .0002) and bacteremia (24 v 9; P = .01) were found in the experimental arm. The cumulative probability of developing at least one CVC complication was higher in the experimental arm than in the standard arm (65.1% [95% CI, 55% to 75%] v 43.8% [95% CI, 34% to 54%], respectively; P = .01). No difference was found in either the cause or the frequency of premature removal of CVCs between the two study arms. After a median follow-up of 360 days (range, 4 to 1,073), CVC survival was similar: 77% (95% CI, 66% to 84%) for the experimental arm and 69% (95% CI, 53% to 80%) for the standard arm (P = .7). The factors associated with the occurrence of CVC complication were a diagnosis of leukemia/lymphoma, double-lumen CVC, and experimental flushing. The only factor significantly associated with premature removal of a CVC was a diagnosis of leukemia/lymphoma (hazard rate, 2.3; 95% CI, 1.1 to 4.7).
  
  
  CONCLUSIONS
  An increased complication rate was found with normal saline flushing, but additional investigation is warranted to clarify whether it is related to saline use or to once-a-week flushing.
authors.affiliation: Pediatric Hematology and Oncology, Department of Pediatrics, University of Padova, Via Giustiniani 3, Padova, Italy 35128; simone.cesaro@unipd.it.
authors.forename: Simone
authors.initials: S
authors.lastname: Cesaro
authors.forename: Gloria
authors.initials: G
authors.lastname: Tridello
authors.forename: Mara
authors.initials: M
authors.lastname: Cavaliere
authors.forename: Laura
authors.initials: L
authors.lastname: Magagna
authors.forename: Patrizia
authors.initials: P
authors.lastname: Gavin
authors.forename: Riccardo
authors.initials: R
authors.lastname: Cusinato
authors.forename: Nicola
authors.initials: N
authors.lastname: Zadra
authors.forename: Giovanni
authors.initials: G
authors.lastname: Franco Zanon
authors.forename: Luigi
authors.initials: L
authors.lastname: Zanesco
authors.forename: Modesto
authors.initials: M
authors.lastname: Carli
mesh_terms: D000293:Adolescent; D000925:Anticoagulants / Q000008:administration & dosage*; D055499:Catheter-Related Infections / Q000209:etiology / Q000517:prevention & control*; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002408:Catheters, Indwelling / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D005260:Female; D019337:Hematologic Neoplasms / Q000188:drug therapy*; D006493:Heparin / Q000008:administration & dosage*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D012965:Sodium Chloride / Q000008:administration & dosage; D015996:Survival Rate; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000209:etiology / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants; D012965:Sodium Chloride; D006493:Heparin