Does low-dose heparin maintain central venous access device patency?: a comparison of heparin versus saline during a period of heparin shortage.
BACKGROUND
A common problem that complicates use of central venous access devices (CVADs) is occlusion by thrombosis. Alteplase, a recombinant tissue plasminogen activator, is used to restore line patency when thrombosis occurs. Heparin flush is commonly used to prevent this complication, but the effectiveness of this practice is unclear. A recent heparin shortage allowed examination of heparin effectiveness in reducing CVAD thrombosis.


METHODS
A retrospective cohort study was performed by querying a pharmacy database for alteplase use for CVAD thrombosis in adult patients during periods when heparin flushes (10 units/mL) were used and when saline flushes were used instead because of a nationwide heparin shortage. The number of patients receiving alteplase, the number of doses administered, and the total amount of alteplase used were compared over 1-month intervals of heparin flush use and 1-month intervals of saline flush use. Patient days and critical care patient days were compared between these time intervals. Peripherally inserted central catheter (PICC) line placements and replacements between time periods of heparin and saline flush were also compared.


RESULTS
Significant increases in the number of patients receiving alteplase (P = .04), the number of alteplase doses administered (P = .04), and total dose of alteplase used (P = .05) occurred during the heparin shortage. No significant differences in patient population were observed. The percentage of PICC line replacements also increased significantly (P < .05) when heparin was not available.


CONCLUSIONS
Heparin flush (10 units/mL) decreases thrombotic occlusions of CVADs, resulting in decreased alteplase use and fewer PICC line replacements.
Jonker
Mark A
MA
Veterans Administration Surgical Services, William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin, USA.
Osterby
Kurt R
KR
Vermeulen
Lee C
LC
Kleppin
Susan M
SM
Kudsk
Kenneth A
KA
D000328:Adult; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000379:methods; D002408:Catheters, Indwelling / Q000009:adverse effects*; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006493:Heparin / Q000008:administration & dosage*; D006801:Humans; D007902:Length of Stay; D012189:Retrospective Studies; D013927:Thrombosis / Q000188:drug therapy / Q000517:prevention & control*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D016896:Treatment Outcome; D014654:Vascular Patency / Q000187:drug effects*
D005343:Fibrinolytic Agents; D006493:Heparin; D010959:Tissue Plasminogen Activator