Flushing effects of normal saline and heparin saline after central venous catheterization: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

WEN Zunjia ¹ ,  SHEN Meifen ² , ZHANG Haiying ² , LIU Qiaoyan ¹ , WANG Zhuo ¹

1. Nursing School of Soochow University, Suzhou, 215002, P.R.China;
2. The First Hospital Affiliated to Soochow University, Suzhou, 215002, P.R.China;

Corresponding author：

SHEN Meifen, Email: smf8165@163.com

Keywords：

Normal saline; Heparin; Central venous catheter; Flush; Systematic review; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.201605051

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To evaluate the flushing effects of normal saline (NS) and heparin saline (HPS) after central venous catheterization. Methods We searched PubMed, EMbase, The Cochrane Library (Issue 12, 2015), CBM, CNKI, VIP and WanFang Data to collect randomized controlled trials (RCTs) on the flushing effects of NS versus HPS after central venous catheterization from inception to December 2015. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then RevMan 5.3 software was used for meta-analysis. Results A total of 12 RCTs involving 2 092 patients were included. The results of meta-analysis showed that no significant differences were found between the two groups in occlusion rate (OR=1.58, 95%CI 0.79 to 3.14,P=0.19) and the catheter days (OR=–7.24, 95%CI –22.90 to 8.41,P=0.36), while the HPS group had more advantage than the NS group in decreasing the incidence of phlebitis (OR=2.57, 95%CI 1.52 to 4.34,P=0.000 4). Subgroup analysis revealed that HPS provided more superiority over NS in lessening the occlusion rate (OR=1.85, 95%CI 1.22 to 2.80,P=0.004), no significant difference was found when comparing NS to 10 units, and 100 units HPS (10 units: OR=1.51, 95%CI 0.94 to 2.43,P=0.09; 100 units: OR=1.51, 95%CI 0.63 to 3.60,P=0.09). Conclusion HPS appears to be more beneficial than NS, larger rigorously studies are needed for better understanding on the effects of NS and HPS.

Citation： WEN Zunjia, SHEN Meifen, ZHANG Haiying, LIU Qiaoyan, WANG Zhuo. Flushing effects of normal saline and heparin saline after central venous catheterization: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2017, 17(1): 58-64. doi: 10.7507/1672-2531.201605051 Copy

1.	Srisan P, Juhong S, Kanjanapatanakul W. Central venous catheterization related complications in Pediatric Intensive Care Unit at Queen Sirikit National Institute of Child Health. J Med Assoc Thai, 2014, 97(6): 83-88.
2.	Lee AY, Levine MN, Butler G,et al. Incidence, risk factors, and outcomes of catheter-related thrombosis in adult patients with cancer. J Clin Oncol, 2006, 24(9): 1404-1408.
3.	Dal Molin A, Allara E, Montani D,et al. Flushing the central venous catheter: is heparin necessary? J Vasc Access, 2014, 15(4): 241-248.
4.	Bradford NK, Edwards RM, Chan RJ. Heparin versus 0.9% sodium chloride intermittent flushing for the prevention of occlusion in long term central venous catheters in infants and children. Cochrane Database Syst Rev, 2015, (11): CD010996.
5.	Brandao LR, Shah N, Shah PS. Low molecular weight heparin for prevention of central venous catheterization-related thrombosis in children. Cochrane Database Syst Rev, 2014, (3): CD005982.
6.	Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0[updated March 2011]. The Cochrane Collaboration, 2011. Available at: www.cochrane-handbook.org.
7.	Mok E, Kwong TK, Chan MF. A randomized controlled trial for maintaining peripheral intravenous lock in children. Int J Nurs Pract, 2007, 13(1): 33-45.
8.	Schallom ME, Prentice D, Sona C,et al. Heparin or 0.9% sodium chloride to maintain central venous catheter patency: a randomized trial. Crit Care Med, 2012, 40(6): 1820-1826.
9.	Niesen KM, Harris DY, Parkin LS,et al. The effects of heparin versus normal saline for maintenance of peripheral intravenous locks in pregnant women. J Obstet Gynecol Neonatal Nurs, 2003, 32(4): 503-508.
10.	Lyons MG, Phalen AG. A randomized controlled comparison of flushing protocols in home care patients with peripherally inserted central catheters. J Infus Nurs, 2014, 37(4): 270-281.
11.	Goossens GA, Jerome M, Janssens C,et al. Comparing normal saline versus diluted heparin to lock non-valved totally implantable venous access devices in cancer patients: a randomised, non-inferiority, open trial. Ann Oncol, 2013, 24(7): 1892-1899.
12.	LeDuc K. Efficacy of normal saline solution versus heparin solution for maintaining patency of peripheral intravenous catheters in children. J Emerg Nurs, 1997, 23(4): 306-309.
13.	White ML, Crawley J, Rennie EA. Examining the effectiveness of 2 solutions used to flush capped pediatric peripheral intravenous catheters. J Infus Nurs, 2011, 34(4): 260-270.
14.	Bertolino G, Pitassi A, Tinelli C,et al. Intermittent flushing with heparin versus saline for maintenance of peripheral intravenous catheters in a medical department: a pragmatic cluster-randomized controlled study. Worldviews Evid Based Nurs, 2012, 9(4): 221-226.
15.	Cesaro S, Tridello G, Cavaliere M,et al. Prospective, randomized trial of two different modalities of flushing central venous catheters in pediatric patients with cancer. J Clin Oncol, 2009, 27(12): 2059-2065.
16.	Fuentes i Pumarola C, Casademont Mercader R, Colomer Plana M,et al. Comparative study of maintenance of patency of triple lumen central venous catheter. Enferm Intensiva, 2007, 18(1): 25-35.
17.	Bowers L, Speroni KG, Jones L,et al. Comparison of occlusion rates by flushing solutions for peripherally inserted central catheters with positive pressure Luer-activated devices. J Infus Nurs, 2008, 31(1): 22-27.
18.	Kaneko Y, Iwano M, Yoshida H. Natural saline-flush is sufficient to maintain patency of immobilized-urokinase double-lumen catheter used to provide temporary blood access for hemodialysis. Blood Purif, 2004, 22(5): 473-479.
19.	Lopez-Briz E, Ruiz Garcia V, Cabello JB,et al. Heparin versus 0.9% sodium chloride intermittent flushing for prevention of occlusion in central venous catheters in adults. Cochrane Database Syst Rev, 2014, (10): CD008462.
20.	Robertson-Malt S, Malt GN, Farquhar V,et al. Heparin versus normal saline for patency of arterial lines. Cochrane Database Syst Rev, 2014, (5): CD007364.
21.	王新田, 李志敏, 钟月欢, 等. 中国静脉留置针肝素钠封管与生理盐水封管效果比较的Meta分析. 中国循证医学杂志, 2011, 11(1): 96-100.
22.	许丽春, 胡雁, 张锦辉, 等. 生理盐水和肝素钠盐水用于成人外周静脉留置针封管有效性的Meta分析. 护理学杂志, 2014, 29(19): 82-86.
23.	Loveday HP, Wilson JA, Pratt RJ. epic3: national evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England. J Hosp Infect, 2014, 86(1): S1-70.
24.	Goossens GA. Flushing and Locking of Venous Catheters: Available Evidence and Evidence Deficit. Nurs Res Pract, 2015(4): 956-986.
25.	Huraib S, Askar A, Abu-Aisha H,et al. Prevalence of infection from subclavian dialysis catheters with two different postinsertion catheter cares: a randomized comparative study. Angiology, 1994, 45(12): 1047-1051.
26.	Randolph AG, Cook DJ, Gonzales CA,et al. A Benefit of heparin in central venous and pulmonary artery catheters: a meta-analysis of randomized controlled trials. Chest, 1998, 113(1): 165-171.
27.	Randolph AG, Cook DJ, Gonzales CA,et al. Benefit of heparin in peripheral venous and arterial catheters: systematic review and meta-analysis of randomised controlled trials. BMJ, 1998, 316(6): 969-975.
28.	Garcia DA, Baglin TP, Weitz J,et al. Parenteral anticoagulants: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest, 2012, 141(2): 24-43.

1. Srisan P, Juhong S, Kanjanapatanakul W. Central venous catheterization related complications in Pediatric Intensive Care Unit at Queen Sirikit National Institute of Child Health. J Med Assoc Thai, 2014, 97(6): 83-88.
2. Lee AY, Levine MN, Butler G,et al. Incidence, risk factors, and outcomes of catheter-related thrombosis in adult patients with cancer. J Clin Oncol, 2006, 24(9): 1404-1408.
3. Dal Molin A, Allara E, Montani D,et al. Flushing the central venous catheter: is heparin necessary? J Vasc Access, 2014, 15(4): 241-248.
4. Bradford NK, Edwards RM, Chan RJ. Heparin versus 0.9% sodium chloride intermittent flushing for the prevention of occlusion in long term central venous catheters in infants and children. Cochrane Database Syst Rev, 2015, (11): CD010996.
5. Brandao LR, Shah N, Shah PS. Low molecular weight heparin for prevention of central venous catheterization-related thrombosis in children. Cochrane Database Syst Rev, 2014, (3): CD005982.
6. Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0[updated March 2011]. The Cochrane Collaboration, 2011. Available at: www.cochrane-handbook.org.
7. Mok E, Kwong TK, Chan MF. A randomized controlled trial for maintaining peripheral intravenous lock in children. Int J Nurs Pract, 2007, 13(1): 33-45.
8. Schallom ME, Prentice D, Sona C,et al. Heparin or 0.9% sodium chloride to maintain central venous catheter patency: a randomized trial. Crit Care Med, 2012, 40(6): 1820-1826.
9. Niesen KM, Harris DY, Parkin LS,et al. The effects of heparin versus normal saline for maintenance of peripheral intravenous locks in pregnant women. J Obstet Gynecol Neonatal Nurs, 2003, 32(4): 503-508.
10. Lyons MG, Phalen AG. A randomized controlled comparison of flushing protocols in home care patients with peripherally inserted central catheters. J Infus Nurs, 2014, 37(4): 270-281.
11. Goossens GA, Jerome M, Janssens C,et al. Comparing normal saline versus diluted heparin to lock non-valved totally implantable venous access devices in cancer patients: a randomised, non-inferiority, open trial. Ann Oncol, 2013, 24(7): 1892-1899.
12. LeDuc K. Efficacy of normal saline solution versus heparin solution for maintaining patency of peripheral intravenous catheters in children. J Emerg Nurs, 1997, 23(4): 306-309.
13. White ML, Crawley J, Rennie EA. Examining the effectiveness of 2 solutions used to flush capped pediatric peripheral intravenous catheters. J Infus Nurs, 2011, 34(4): 260-270.
14. Bertolino G, Pitassi A, Tinelli C,et al. Intermittent flushing with heparin versus saline for maintenance of peripheral intravenous catheters in a medical department: a pragmatic cluster-randomized controlled study. Worldviews Evid Based Nurs, 2012, 9(4): 221-226.
15. Cesaro S, Tridello G, Cavaliere M,et al. Prospective, randomized trial of two different modalities of flushing central venous catheters in pediatric patients with cancer. J Clin Oncol, 2009, 27(12): 2059-2065.
16. Fuentes i Pumarola C, Casademont Mercader R, Colomer Plana M,et al. Comparative study of maintenance of patency of triple lumen central venous catheter. Enferm Intensiva, 2007, 18(1): 25-35.
17. Bowers L, Speroni KG, Jones L,et al. Comparison of occlusion rates by flushing solutions for peripherally inserted central catheters with positive pressure Luer-activated devices. J Infus Nurs, 2008, 31(1): 22-27.
18. Kaneko Y, Iwano M, Yoshida H. Natural saline-flush is sufficient to maintain patency of immobilized-urokinase double-lumen catheter used to provide temporary blood access for hemodialysis. Blood Purif, 2004, 22(5): 473-479.
19. Lopez-Briz E, Ruiz Garcia V, Cabello JB,et al. Heparin versus 0.9% sodium chloride intermittent flushing for prevention of occlusion in central venous catheters in adults. Cochrane Database Syst Rev, 2014, (10): CD008462.
20. Robertson-Malt S, Malt GN, Farquhar V,et al. Heparin versus normal saline for patency of arterial lines. Cochrane Database Syst Rev, 2014, (5): CD007364.
21. 王新田, 李志敏, 钟月欢, 等. 中国静脉留置针肝素钠封管与生理盐水封管效果比较的Meta分析. 中国循证医学杂志, 2011, 11(1): 96-100.
22. 许丽春, 胡雁, 张锦辉, 等. 生理盐水和肝素钠盐水用于成人外周静脉留置针封管有效性的Meta分析. 护理学杂志, 2014, 29(19): 82-86.
23. Loveday HP, Wilson JA, Pratt RJ. epic3: national evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England. J Hosp Infect, 2014, 86(1): S1-70.
24. Goossens GA. Flushing and Locking of Venous Catheters: Available Evidence and Evidence Deficit. Nurs Res Pract, 2015(4): 956-986.
25. Huraib S, Askar A, Abu-Aisha H,et al. Prevalence of infection from subclavian dialysis catheters with two different postinsertion catheter cares: a randomized comparative study. Angiology, 1994, 45(12): 1047-1051.
26. Randolph AG, Cook DJ, Gonzales CA,et al. A Benefit of heparin in central venous and pulmonary artery catheters: a meta-analysis of randomized controlled trials. Chest, 1998, 113(1): 165-171.
27. Randolph AG, Cook DJ, Gonzales CA,et al. Benefit of heparin in peripheral venous and arterial catheters: systematic review and meta-analysis of randomised controlled trials. BMJ, 1998, 316(6): 969-975.
28. Garcia DA, Baglin TP, Weitz J,et al. Parenteral anticoagulants: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest, 2012, 141(2): 24-43.

Chinese Journal of Evidence-Based Medicine

Flushing effects of normal saline and heparin saline after central venous catheterization: a meta-analysis

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content