Heparin flushing and other interventions to maintain patency of central venous catheters: a systematic review
Title. Heparin flushing and other interventions to maintain patency of central venous catheters: a systematic review. Aim. 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. Flush...
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| Veröffentlicht in: | Journal of advanced nursing 2009-10, Vol.65 (10), p.2007-2021 |
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| creator | Mitchell, Matthew D. Anderson, Barbara Jo Williams, Kendal Umscheid, Craig A. |
| description | Title. Heparin flushing and other interventions to maintain patency of central venous catheters: a systematic review.
Aim. 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.
Data sources. 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.
Conclusion. 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. |
| doi_str_mv | 10.1111/j.1365-2648.2009.05103.x |
| format | Article |
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Aim. 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.
Data sources. 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.
Conclusion. 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.</description><identifier>ISSN: 0309-2402</identifier><identifier>EISSN: 1365-2648</identifier><identifier>DOI: 10.1111/j.1365-2648.2009.05103.x</identifier><identifier>PMID: 20568318</identifier><language>eng</language><publisher>Oxford, UK: Blackwell Publishing Ltd</publisher><subject><![CDATA[Adult ; Anticoagulants - administration & dosage ; Anticoagulants - adverse effects ; Carbohydrates ; Catheter-Related Infections - etiology ; Catheter-Related Infections - prevention & control ; Catheterization, Central Venous - instrumentation ; Catheters ; central venous catheters ; Child ; Child, Preschool ; Equipment Failure ; Evidence-Based Practice ; Heparin - administration & dosage ; Heparin - adverse effects ; heparin flushing ; Humans ; Infant ; Infusions, Intra-Arterial - instrumentation ; Intervention ; interventions ; Medical research ; Nursing ; Nursing Research - methods ; patency ; Practice Guidelines as Topic ; Sodium Chloride - administration & dosage ; systematic review ; Thrombocytopenia - chemically induced ; Thrombosis - prevention & control ; Treatment Outcome ; Urokinase-Type Plasminogen Activator - administration & dosage]]></subject><ispartof>Journal of advanced nursing, 2009-10, Vol.65 (10), p.2007-2021</ispartof><rights>2009 Blackwell Publishing Ltd</rights><rights>Copyright Blackwell Publishing Ltd. Oct 2009</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4653-a930035b6d4d0d3f9e6c49a4331f270f665f6202ddbf759ba342dd399daf7e43</citedby><cites>FETCH-LOGICAL-c4653-a930035b6d4d0d3f9e6c49a4331f270f665f6202ddbf759ba342dd399daf7e43</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fj.1365-2648.2009.05103.x$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fj.1365-2648.2009.05103.x$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,30999,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/20568318$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Mitchell, Matthew D.</creatorcontrib><creatorcontrib>Anderson, Barbara Jo</creatorcontrib><creatorcontrib>Williams, Kendal</creatorcontrib><creatorcontrib>Umscheid, Craig A.</creatorcontrib><title>Heparin flushing and other interventions to maintain patency of central venous catheters: a systematic review</title><title>Journal of advanced nursing</title><addtitle>J Adv Nurs</addtitle><description>Title. Heparin flushing and other interventions to maintain patency of central venous catheters: a systematic review.
Aim. 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.
Data sources. 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.
Conclusion. 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.</description><subject>Adult</subject><subject>Anticoagulants - administration & dosage</subject><subject>Anticoagulants - adverse effects</subject><subject>Carbohydrates</subject><subject>Catheter-Related Infections - etiology</subject><subject>Catheter-Related Infections - prevention & control</subject><subject>Catheterization, Central Venous - instrumentation</subject><subject>Catheters</subject><subject>central venous catheters</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Equipment Failure</subject><subject>Evidence-Based Practice</subject><subject>Heparin - administration & dosage</subject><subject>Heparin - adverse effects</subject><subject>heparin flushing</subject><subject>Humans</subject><subject>Infant</subject><subject>Infusions, Intra-Arterial - instrumentation</subject><subject>Intervention</subject><subject>interventions</subject><subject>Medical research</subject><subject>Nursing</subject><subject>Nursing Research - methods</subject><subject>patency</subject><subject>Practice Guidelines as Topic</subject><subject>Sodium Chloride - administration & dosage</subject><subject>systematic review</subject><subject>Thrombocytopenia - chemically induced</subject><subject>Thrombosis - prevention & control</subject><subject>Treatment Outcome</subject><subject>Urokinase-Type Plasminogen Activator - administration & dosage</subject><issn>0309-2402</issn><issn>1365-2648</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2009</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>7QJ</sourceid><recordid>eNqNkUFPHCEUx4mx0dX6FQzpxdNMGR4wg0kPxlRts7VpNOmRsDNQ2c4wW5jR3W9fpmv34EVJCC-83-8F8kcIFyQv0vq4zAsQPKOCVTklROaEFwTy9R6a7Rr7aEaAyIwyQg_RUYxLQgqglB6gQ0q4qKCoZqi7MSsdnMe2HeOD87-w9g3uhwcTsPODCY_GD673EQ897nS6Shuv9GB8vcG9xXXqB93ixPVjxLVOatLiOdY4buJgOj24Ggfz6MzTe_TO6jaak-fzGN1ffb6_vMnm36-_XF7Ms5oJDpmWQAjwhWhYQxqw0oiaSc0ACktLYoXgVlBCm2ZhSy4XGliqQcpG29IwOEZn27Gr0P8ZTRxU52Jt2lZ7kx6pSsFAUirhdRIASsqgSuSHF-SyH4NPv1AUKJOMswmqtlAd-hiDsWoVXKfDRhVETcmppZoCUlNAakpO_UtOrZN6-jx_XHSm2Yn_o0rApy3w5FqzefNg9fXidqqSn219l0JZ73wdfitRQsnVz9tr9UPe3ZXz6psC-AtMIrbn</recordid><startdate>200910</startdate><enddate>200910</enddate><creator>Mitchell, Matthew D.</creator><creator>Anderson, Barbara Jo</creator><creator>Williams, Kendal</creator><creator>Umscheid, Craig A.</creator><general>Blackwell Publishing Ltd</general><general>Wiley Subscription Services, Inc</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QJ</scope><scope>ASE</scope><scope>FPQ</scope><scope>K6X</scope><scope>NAPCQ</scope><scope>7X8</scope></search><sort><creationdate>200910</creationdate><title>Heparin flushing and other interventions to maintain patency of central venous catheters: a systematic review</title><author>Mitchell, Matthew D. ; Anderson, Barbara Jo ; Williams, Kendal ; Umscheid, Craig A.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4653-a930035b6d4d0d3f9e6c49a4331f270f665f6202ddbf759ba342dd399daf7e43</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2009</creationdate><topic>Adult</topic><topic>Anticoagulants - administration & dosage</topic><topic>Anticoagulants - adverse effects</topic><topic>Carbohydrates</topic><topic>Catheter-Related Infections - etiology</topic><topic>Catheter-Related Infections - prevention & control</topic><topic>Catheterization, Central Venous - instrumentation</topic><topic>Catheters</topic><topic>central venous catheters</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Equipment Failure</topic><topic>Evidence-Based Practice</topic><topic>Heparin - administration & dosage</topic><topic>Heparin - adverse effects</topic><topic>heparin flushing</topic><topic>Humans</topic><topic>Infant</topic><topic>Infusions, Intra-Arterial - instrumentation</topic><topic>Intervention</topic><topic>interventions</topic><topic>Medical research</topic><topic>Nursing</topic><topic>Nursing Research - methods</topic><topic>patency</topic><topic>Practice Guidelines as Topic</topic><topic>Sodium Chloride - administration & dosage</topic><topic>systematic review</topic><topic>Thrombocytopenia - chemically induced</topic><topic>Thrombosis - prevention & control</topic><topic>Treatment Outcome</topic><topic>Urokinase-Type Plasminogen Activator - administration & dosage</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Mitchell, Matthew D.</creatorcontrib><creatorcontrib>Anderson, Barbara Jo</creatorcontrib><creatorcontrib>Williams, Kendal</creatorcontrib><creatorcontrib>Umscheid, Craig A.</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Applied Social Sciences Index & Abstracts (ASSIA)</collection><collection>British Nursing Index</collection><collection>British Nursing Index (BNI) (1985 to Present)</collection><collection>British Nursing Index</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of advanced nursing</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Mitchell, Matthew D.</au><au>Anderson, Barbara Jo</au><au>Williams, Kendal</au><au>Umscheid, Craig A.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Heparin flushing and other interventions to maintain patency of central venous catheters: a systematic review</atitle><jtitle>Journal of advanced nursing</jtitle><addtitle>J Adv Nurs</addtitle><date>2009-10</date><risdate>2009</risdate><volume>65</volume><issue>10</issue><spage>2007</spage><epage>2021</epage><pages>2007-2021</pages><issn>0309-2402</issn><eissn>1365-2648</eissn><abstract>Title. Heparin flushing and other interventions to maintain patency of central venous catheters: a systematic review.
Aim. 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.
Data sources. 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.
Conclusion. 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.</abstract><cop>Oxford, UK</cop><pub>Blackwell Publishing Ltd</pub><pmid>20568318</pmid><doi>10.1111/j.1365-2648.2009.05103.x</doi><tpages>15</tpages></addata></record> |
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| source | Wiley Online Library - AutoHoldings Journals; MEDLINE; Applied Social Sciences Index & Abstracts (ASSIA) |
| subjects | Adult Anticoagulants - administration & dosage Anticoagulants - adverse effects Carbohydrates Catheter-Related Infections - etiology Catheter-Related Infections - prevention & control Catheterization, Central Venous - instrumentation Catheters central venous catheters Child Child, Preschool Equipment Failure Evidence-Based Practice Heparin - administration & dosage Heparin - adverse effects heparin flushing Humans Infant Infusions, Intra-Arterial - instrumentation Intervention interventions Medical research Nursing Nursing Research - methods patency Practice Guidelines as Topic Sodium Chloride - administration & dosage systematic review Thrombocytopenia - chemically induced Thrombosis - prevention & control Treatment Outcome Urokinase-Type Plasminogen Activator - administration & dosage |
| title | Heparin flushing and other interventions to maintain patency of central venous catheters: a systematic review |
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