Heparin Added in Total Nutrient Admixture for Preventing Peripherally Inserted Central Catheter Occlusion in Neonate: A Case Report_Chinese Journal of Evidence-Based Medicine

Authors：

 WAN XingLi ¹ , ZENG LiNan ²

1. Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu 610041, China;2. Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu 610041, China;

Corresponding author：

WAN XingLi, Email: xingliwan@126.com

Keywords：

Neonate; Peripherally inserted central catheter; Catheter occlusion; Heparin; Evidence-based treatment; Total nutrient admixture

DOI：

10.7507/1672-2531.20120198

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective 　To make an individualized administration scheme via evidence-based medicine methods, namely adding heparin into the total nutrient admixture (TNA) solution, so as to help a neonate to prevent the occlusion of peripherally inserted central catheter (PICC).
Methods 　After carefully assessing the condition of neonate, this clinical issue was put forward in accordance with the PICO principles. Randomized controlled trials (RCTs) and systematic reviews on neonates’ PICC occlusion were collected from The Cochrane Library, CCTR, DARE, NGC, MEDLINE (Ovid) and CBM from inception to 2011. The clinical intervention scheme was finally made after the assessment of the retrieved evidence and neonate’s physiological condition.
Results 　A total of 4 RCTs and 1 systematic review related to the issues were identified. The following scheme was finally made for the neonate through the assessment of the retrieved evidence and combination of intentions of the patient’s family members: heparin (0.5 U/mL) was added into TNA to prevent PICC occlusion. During the application, blood routine test and blood coagulation were monitored, and the catheter opening time and extubation reason were recorded. Through the above treatment, the neonate successfully completed the treatment before extubation. The time of both PICC detaining and opening was 20 days in total, and there were no PICC occlusion, no catheter thrombosis, and no catheter related bloodstream infection. Moreover, no observation showed thrombopenia and aggravated coagulation disorders resulted from heparin.
Conclusion 　The evidence-based medicine method is an effective way to make reasonable heparin scheme for neonate, so as to prevent PICC occlusion, reduce catheter thrombosis, decrease risks of catheter related blood circulation infection, assure successful completion of treatment, and guarantee the safety of patients.

Citation： WAN XingLi,ZENG LiNan. Heparin Added in Total Nutrient Admixture for Preventing Peripherally Inserted Central Catheter Occlusion in Neonate: A Case Report. Chinese Journal of Evidence-Based Medicine, 2012, 12(10): 1275-1278. doi: 10.7507/1672-2531.20120198 Copy

1.	唐军, 熊英. 肝素预防新生儿经外周中心静脉置管相关感染的回顾性研究. 中国循证医学杂志, 2010, 10(9): 1023-1026.
2.	王晓燕, 佘燕朝, 公庆华, 等. 中心静脉导管堵塞原因及对策. 护理研究, 2007, 21(6): 1519-1521.
3.	唐军, 李熙鸿, 王华, 等. 静脉营养液中加入小剂量肝素预防新生儿中心静脉置管相关感染. 中国当代儿科杂志, 2009, 11(12): 983-985.
4.	Harms K, Herting E, Kruger T, et al. Percutaneous silastic catheters in newborn and prematureinfants. A report of experience with 497 catheters in 5 years. Monatsschrift fur Kinderheilkd, 1992, 140(638): 464-471.
5.	Klein JF, Shahrivar F. Use of percutaneous silastic central venous catheters in neonates and the management of infectious complications. American Journal of Perinatology, 1992, 9(32): 261-264.
6.	Randolph AG, Cook DJ, Gonzales CA, et al. Bene?t of heparin in peripheral venous and arterial catheters: systematic review and meta-analysis of randomized controlled trials. BMJ, 1998, 316(322): 969-975.
7.	Schmidt B, Andrew M. Neonatal thrombotic disease: prevention, diagnosis, and treatment. Journal of Pediatrics, 1988, 113(21): 407-410.
8.	Brismar B, Hardstedt C, Jacobson S, et al. Reduction ofcatheter-associated thrombosis in parenteral nutrition by intravenous heparin therapy. Archives of Surgery, 1982, 117(76): 1196-1199.
9.	Kamala F, Boo NY, Cheah FC, et al. Randomized controlled trial of heparin for prevention of blockage of peripherally inserted central catheters in neonates. Acta Paediatrica, 2002, 91(12): 1350-1356.
10.	Shah PS, Kalyn A, Satodia P, et al. 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. Pediatrics, 2007, 119(1): 284-291.
11.	Birch P, Ogden S, Hewson M. A randomised controlled trial of heparin in total parenteral nutrition to prevent sepsis associated with neonatal long lines: the Heparin in Long Line Total Parenteral Nutrition (HILLTOP) trial. Archives of Diseases of Childhood Fetal and Neonatal Edition, 2010, 95(16): 252-257.
12.	Uslu S, Ozdemir H, Comert S, et al. The effect of low-dose heparin on maintaining peripherally inserted percutaneous central venous catheters in neonates. Journal of Perinatology: official journal of the California Perinatal Association, 2010, 30(12): 794-799.
13.	Shah PS, Shah VS. Continuous heparin infusion to preventthrombosis and catheter occlusion in neonates with peripherally placed percutaneous central venous catheters. Cochrane Database of Systematic Reviews 2008, Issue 2. Art. No.: CD002772. DOI: 10.1002/14651858. CD002772. pub3.
14.	蒋倩, 蒋刚, 周澄亚. 1例复发性卵巢癌患者的循证治疗. 中国循证医学杂志, 2011, 11(11): 1339-1341.

1. 唐军, 熊英. 肝素预防新生儿经外周中心静脉置管相关感染的回顾性研究. 中国循证医学杂志, 2010, 10(9): 1023-1026.
2. 王晓燕, 佘燕朝, 公庆华, 等. 中心静脉导管堵塞原因及对策. 护理研究, 2007, 21(6): 1519-1521.
3. 唐军, 李熙鸿, 王华, 等. 静脉营养液中加入小剂量肝素预防新生儿中心静脉置管相关感染. 中国当代儿科杂志, 2009, 11(12): 983-985.
4. Harms K, Herting E, Kruger T, et al. Percutaneous silastic catheters in newborn and prematureinfants. A report of experience with 497 catheters in 5 years. Monatsschrift fur Kinderheilkd, 1992, 140(638): 464-471.
5. Klein JF, Shahrivar F. Use of percutaneous silastic central venous catheters in neonates and the management of infectious complications. American Journal of Perinatology, 1992, 9(32): 261-264.
6. Randolph AG, Cook DJ, Gonzales CA, et al. Bene?t of heparin in peripheral venous and arterial catheters: systematic review and meta-analysis of randomized controlled trials. BMJ, 1998, 316(322): 969-975.
7. Schmidt B, Andrew M. Neonatal thrombotic disease: prevention, diagnosis, and treatment. Journal of Pediatrics, 1988, 113(21): 407-410.
8. Brismar B, Hardstedt C, Jacobson S, et al. Reduction ofcatheter-associated thrombosis in parenteral nutrition by intravenous heparin therapy. Archives of Surgery, 1982, 117(76): 1196-1199.
9. Kamala F, Boo NY, Cheah FC, et al. Randomized controlled trial of heparin for prevention of blockage of peripherally inserted central catheters in neonates. Acta Paediatrica, 2002, 91(12): 1350-1356.
10. Shah PS, Kalyn A, Satodia P, et al. 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. Pediatrics, 2007, 119(1): 284-291.
11. Birch P, Ogden S, Hewson M. A randomised controlled trial of heparin in total parenteral nutrition to prevent sepsis associated with neonatal long lines: the Heparin in Long Line Total Parenteral Nutrition (HILLTOP) trial. Archives of Diseases of Childhood Fetal and Neonatal Edition, 2010, 95(16): 252-257.
12. Uslu S, Ozdemir H, Comert S, et al. The effect of low-dose heparin on maintaining peripherally inserted percutaneous central venous catheters in neonates. Journal of Perinatology: official journal of the California Perinatal Association, 2010, 30(12): 794-799.
13. Shah PS, Shah VS. Continuous heparin infusion to preventthrombosis and catheter occlusion in neonates with peripherally placed percutaneous central venous catheters. Cochrane Database of Systematic Reviews 2008, Issue 2. Art. No.: CD002772. DOI: 10.1002/14651858. CD002772. pub3.
14. 蒋倩, 蒋刚, 周澄亚. 1例复发性卵巢癌患者的循证治疗. 中国循证医学杂志, 2011, 11(11): 1339-1341.

Chinese Journal of Evidence-Based Medicine

Heparin Added in Total Nutrient Admixture for Preventing Peripherally Inserted Central Catheter Occlusion in Neonate: A Case Report

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