title: Heparin flushing and other interventions to maintain patency of central venous catheters: a systematic review.
abstract: OBJECTIVE
  This paper is a report of a review to assess clinical studies comparing the effectiveness of different means of maintaining central venous catheter patency.
  
  
  BACKGROUND
  Flushing with heparin is a routine part of central venous catheter maintenance, but it presents risks, including heparin-induced thrombocytopenia. Other techniques used to prevent occlusion of catheters include saline flushes, heparin-bonded catheters and pressure caps.
  
  
  METHODS
  A search was conducted using the MEDLINE, CINAHL, EMBASE, Cochrane, National Guideline Clearinghouse and University Healthsystem Consortium databases.
  
  
  METHODS
  A systematic review of effectiveness was conducted, using GRADE criteria to assess the strength of evidence for each intervention. The review period covered 1982 or earlier to January 2008.
  
  
  RESULTS
  There is weak evidence that heparin flushing reduces occlusion of catheters, but no evidence that it reduces bloodstream infections. Results from clinical trials of pressure caps are inconsistent regarding their ability to maintain catheter patency, but provide moderate evidence that at least some varieties of caps are associated with increased bloodstream infections.
  
  
  CONCLUSIONS
  The evidence base on heparin flushing and other interventions to prevent catheter occlusion is small, and published studies are of low quality. There is insufficient evidence on which to conclude that flushing catheters with heparin is more effective than flushing with saline solution.
authors.affiliation: Center for Evidence-based Practice, University of Pennsylvania Health System, Philadelphia, USA. mdmitchell@uphs.upenn.edu
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Mitchell
authors.forename: Barbara Jo
authors.initials: BJ
authors.lastname: Anderson
authors.forename: Kendal
authors.initials: K
authors.lastname: Williams
authors.forename: Craig A
authors.initials: CA
authors.lastname: Umscheid
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D055499:Catheter-Related Infections / Q000209:etiology / Q000517:prevention & control*; D002405:Catheterization, Central Venous / Q000295:instrumentation*; D002648:Child; D002675:Child, Preschool; D004868:Equipment Failure; D055317:Evidence-Based Practice; D006493:Heparin / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D007223:Infant; D007261:Infusions, Intra-Arterial / Q000295:instrumentation; D015399:Nursing Research / Q000379:methods; D017410:Practice Guidelines as Topic; D012965:Sodium Chloride / Q000008:administration & dosage; D013921:Thrombocytopenia / Q000139:chemically induced; D013927:Thrombosis / Q000517:prevention & control; D016896:Treatment Outcome; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage
chemical_list: D000925:Anticoagulants; D012965:Sodium Chloride; D006493:Heparin; D014568:Urokinase-Type Plasminogen Activator