Heparin flushing and other interventions to maintain patency of central venous catheters: a systematic review.
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.
Mitchell
Matthew D
MD
Center for Evidence-based Practice, University of Pennsylvania Health System, Philadelphia, USA. mdmitchell@uphs.upenn.edu
Anderson
Barbara Jo
BJ
Williams
Kendal
K
Umscheid
Craig A
CA
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
D000925:Anticoagulants; D012965:Sodium Chloride; D006493:Heparin; D014568:Urokinase-Type Plasminogen Activator