By: Amit ., Rajpati ., and Dhruva Chaudhry.
1NURSE PRACTITIONER, DEPARTMENT OF CRITICAL CARE NURSING, COLLEGE OF NURSING, PT.B. D SHARMA UNIVERSITY OF HEALTH SCIENCES, ROHTAK, HARYANA
2Lecturer, DEPARTMENT OF CRITICAL CARE NURSING, College of Nursing, Pt B.D Sharma PGIMS, Rohtak
Sr. Professor & Head, Department of PCCM, Pt B.D Sharma, PGIMS, Rohtak.
Background: Central venous catheters (CVCs) are frequently utilized in healthcare environments, especially within intensive care units (ICUs), for various medical purposes. They are inserted to facilitate the delivery of fluids, blood products, medications, parenteral nutrition, as well as for monitoring central venous pressure and performing dialysis. Objectives: The main objective of the study was to assess the effectiveness of heparin saline compared to 0.9% sodium chloride in ensuring the patency of central venous catheters in the PCCM department at PGIMS, Rohtak. Methods: A randomized controlled trial included 100 patients with central venous catheters, selected using a sequentially numbered, snose sampling method. The study assessed the impact of heparin saline and 0.9% sodium chloride solution on maintaining catheter patency using a checklist, with evaluations conducted on days 1, 3, and 5. Variables under study dependent variables such as patency of central venous catheter and independent variables such as Heparin saline and normal saline Results: Overall, Heparin Saline appears to be more effective in maintaining the patency of the central venous catheter compared to 0.9% Sodium Chloride particularly on Day 3 and Day 5. Heparin Saline shows higher mean scores and lower variability (smaller standard deviations) across all three days compared to 0.9% Sodium Chloride. The t-tests confirm that the difference in means between Heparin Saline and 0.9% Sodium Chloride is statistically significant on Day 3 and Day 5 suggesting a consistent advantage of Heparin Saline in maintaining catheter patency on these days. Conclusion: The study was conducted on patient with central venous catheter. The study sample was 100.The sample was divided in to group 1 heparin saline and group 2 normal saline each containing 50 subjects. Heparin saline flush was applied on the subjects of group 1 two times a day on day1, day3 and day5 whereas normal saline flush was applied on subjects of group 2 two times a day on day1, day3 and day5.The result of the finding showed that both the interventions were helpful in maintaining patency of central venous catheter but the heparin saline was more effective.
KEYWORDS: Heparin Saline, 0.9% Sodium Chloride, Substitution, Physical health care needs, Mental health care needs.
Citation:
Refrences:
1. Kwakman PH, Müller MC, Binnekade JM, van den Akker JP, de Borgie CA, Schultz MJ, Zaat SA. Medical-grade honey does not reduce skin colonization at central venous catheter-insertion sites of critically ill patients: a randomized controlled trial. Critical Care. 2012 Oct;16(5):1-8.
2. Schallom ME, Prentice D, Sona C, Micek ST, Skrupky LP. Heparin or 0.9% sodium chloride to maintain central venous catheter patency: a randomized trial. Critical care medicine. 2012 Jun 1;40(6):1820-6.
3. 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 Nov 23;(11):CD010996. doi: 10.1002/14651858.CD010996.pub2. Update in: Cochrane Database Syst Rev. 2020 Apr 30;4:CD010996. doi: 10.1002/14651858.CD010996.pub3. PMID: 26590504.
4. Smith RN, Nolan JP. Central venous catheters. BMJ. 2013 Nov 11;347:f6570. doi: 10.1136/bmj.f6570. PMID: 24217269 .
5. Schuster M, Nave H, Piepenbrock S, Pabst R, Panning B. The carina as a landmark in central venous catheter placement. Br J Anaesth. 2000 Aug;85(2):192-4. PMID: 10992822.
6. Gonzalez G, Davidoff AM, Howard SC, Pui CH, Rao BN, Shenep JL, Wozniak A, Shochat SJ. Safety of central venous catheter placement at diagnosis of acute lymphoblastic leukemia in children. Pediatric blood & cancer. 2012 Apr;58(4):498-502.
7. Mitchell MD, Anderson BJ, Williams K, Umscheid CA. Heparin flushing and other interventions to maintain patency of central venous catheters: a systematic review. Journal of advanced nursing. 2009 Oct;65(10):2007-21.
8. Mermel LA. Prevention of intravascular catheter–related infections. Annals of internal medicine. 2000 Mar 7;132(5):391-402.
9. Eisen LA, Narasimhan M, Berger JS, Mayo PH, Rosen MJ, Schneider RF. Mechanical complications of central venous catheters. Journal of intensive care medicine. 2006 Jan;21(1):40-6.
10. McGee DC, Gould MK. Preventing complications of central venous catheterization. New England journal of medicine. 2003 Mar 20;348(12):1123-33.
11. Raad I, Darouiche R, Dupuis J, Abi-Said D, Gabrielli A, Hachem R, Wall M, Harris R, Jones J, Buzaid A, Robertson C. Central venous catheters coated with minocycline and rifampin for the prevention of catheter-related colonization and bloodstream infections: a andomized, double-blind trial. Annals of internal medicine. 1997 Aug 15;127(4):267-74.
12. Veenstra DL, Saint S, Saha S, Lumley T, Sullivan SD. Efficacy of antiseptic-impregnated central venous catheters in preventing catheter-related bloodstream infection: a meta-analysis. Jama. 1999 Jan 20;281(3):261-7.
13. Warkentin TE, Chong BH, Greinacher A. Heparin-induced thrombocytopenia: towards consensus. Thrombosis and haemostasis. 1998 Feb;59(01):1-7.
14. Bonizzoli M, Batacchi S, Cianchi G, Zagli G, Lapi F, Tucci V, Martini G, Di Valvasone S, Peris A. Peripherally inserted central venous catheters and central venous catheters related thrombosis in post-critical patients. Intensive Care Med. 2011 Feb;37(2):284-9. doi: 10.1007/s00134-010-2043-x. Epub 2010 Sep 21. PMID: 20857280 .
15. Mitchell MD, Anderson BJ, Williams K, Umscheid CA. Heparin flushing and other interventions to maintain patency of central venous catheters: a systematic review. Journal of advanced nursing. 2009 Oct;65(10):2007-21.
16. Sona C, Prentice D, Schallom L. National survey of central venous catheter flushing in the intensive care unit. Critical Care Nurse. 2012 Feb;32(1):e12-9.
17. Zhong L, Wang HL, Xu B, Yuan Y, Wang X, Zhang YY, Ji L, Pan ZM, Hu ZS. Normal saline versus heparin for patency of central venous catheters in adult patients – a systematic review and meta-analysis. Crit Care. 2017 Jan 8;21(1):5. doi: 10.1186/s13054-016-1585-x. PMID: 28063456; PMCID: PMC5219914.
18. Beigi AA, HadiZadeh MS, Salimi F, Ghaheri H. Heparin compared with normal saline to maintain patency of permanent double lumen hemodialysis catheters: a randomized controlled trial. Advanced biomedical research. 2014; Beigi AA, HadiZadeh MS, Salimi F, Ghaheri H. Heparin compared with normal saline to maintain patency of permanent double lumen hemodialysis catheters: A randomized controlled trial. Adv Biomed Res. 2014 May 28;3:121. doi: 10.4103/2277-9175.133192. PMID: 24949292; PMCID: PMC4063117.
19. Patidar AB, Choudhary M, Bindu K, Midha V. Comparative efficacy of heparin saline and normal saline flush for maintaining patency of peripheral intravenous lines: a randomized control trial. Int J Health Sci Res [Internet]. 2014 Mar;4(3):159-166.
20. Bradford NK, Edwards RM, Chan RJ. Normal saline (0.9% sodium chloride) versus heparin intermittent flushing for the prevention of occlusion in long-term central venous catheters in infants and children. Cochrane Database Syst Rev. 2020 Apr 30;4(4):CD010996. doi: 10.1002/14651858.CD010996.pub3. PMID: 32352563; PMCID: PMC7192095.
21. : Beigi AA, HadiZadeh MS, Salimi F, Ghaheri H. Heparin compared with normal saline to maintain patency of permanent double lumen hemodialysis catheters: a randomized controlled trial. Advanced biomedical research. 2014 Jan 1;3(1):121.
22. Kim JH, Seo EJ, Park HJ, Kim SH, Min J, Park JY, Kim SC. Comparison of Heparin Solution and 0.9% Normal Saline Solution Flushing to Secure the Patency of Non-Tunneled Central Venous Catheters. Journal of Korean Clinical Nursing Research. 2014;20(3):326-36.
23. Kordzadeh A, Austin T, Panayiotopoulos Y. Efficacy of normal saline in the maintenance of the arterial lines in comparison to heparin flush: a comprehensive review of the literature. The journal of vascular access. 2014 Mar;15(2):123-7.
24. Sharma SK, Mudgal SK, Gaur R, Sharma R, Sharma M, Thakur K. Heparin flush vs. normal saline flush to maintain the patency of central venous catheter among adult patients: A systematic review and meta-analysis. Journal of family medicine and primary care. 2019 Sep 30;8(9):2779-92.
25. López-Briz E, Ruiz Garcia V, Cabello JB, Bort-Martí S, Carbonell Sanchis R. Heparin versus 0.9% sodium chloride locking for prevention of occlusion in central venous catheters in adults. Cochrane Database Syst Rev. 2022 Jul 18;7(7):CD008462. doi: 10.1002/14651858.CD008462.pub4. PMID: 35849083; PMCID: PMC9291254.
26. Santos EJ, Nunes MM, Cardoso DF, Apóstolo JL, Queirós PJ, Rodrigues MA. Effectiveness of heparin versus 0.9% saline solution in maintaining the permeability of central venous catheters: a systematic review. Revista da Escola de Enfermagem da USP. 2015;49:995-1003.
27. Bradford NK, Edwards RM, Chan RJ. Normal saline (0.9% sodium chloride) versus heparin intermittent flushing for the prevention of occlusion in long‐term central venous catheters in infants and children. Cochrane Database of Systematic Reviews. 2020(4).
28. Xu L, Hu Y, Huang X, Fu J, Zhang J. Heparinized saline versus normal saline for maintaining peripheral venous catheter patency in China: An open-label, randomized controlled study. Journal of International Medical Research. 2017 Apr;45(2):471-80.
29. Sotnikova C, Fasoi G, Efstathiou F, Kaba E, Bourazani M, Kelesi M. The efficacy of normal saline (N/S 0.9%) versus heparin solution in maintaining patency of peripheral venous catheter and avoiding complications: a systematic review. Materia Socio-medica. 2020 Mar;32(1):29.
30. Omidi A, Ghalenoo SR, Zadeh NM, Khosravi F. Evaluating the efficacy of heparin flush vs. normal saline flush to maintain the patency of central venous catheter among adult patients: A systematic review and meta-analysis. EurAsian Journal of BioSciences. 2020;14(2):7793-801.
31. Kim JH, Seo EJ, Park HJ, Kim SH, Min J, Park JY, Kim SC. Comparison of Heparin Solution and 0.9% Normal Saline Solution Flushing to Secure the Patency of Non-Tunneled Central Venous Catheters. Journal of Korean Clinical Nursing Research. 2014;20(3):326-36.
32. Schreiber S, Zanchi C, Ronfani L, Delise A, Corbelli A, Bortoluzzi R, Taddio A, Barbi E. Normal saline flushes performed once daily maintain peripheral intravenous catheter patency: a randomised controlled trial. Archives of disease in childhood. 2015 Jul 1;100(7):700-3.
33. : Zhang J, Wang B, Wang J, Yang Q. Ethanol locks for the prevention of catheter-related infection in patients with central venous catheter: a systematic review and meta-analysis of randomized controlled trials. PLoS One. 2019 Sep 12;14(9):e0222408.
34. Mathews T, Acharya LD, Lewis LE, Bhaskar RU, Rahim AA, Prajapati VB, Guddattu V, Mathews M. Effectiveness and Safety of Heparinized Saline versus Normal Saline in Maintaining Patency of Peripheral Intravenous Locks in Neonates at a Tertiary Care Hospital. Journal of Clinical & Diagnostic Research. 2017 Oct 1;11(10).
35. Ullman AJ, Edwards R, Walker R, Roy J, Paton A, Rickard CM, Cooke M, Bradford N, Gibson V, Cattanach P, Paterson RS. Routine catheter lock solutions in pediatric cancer care: A pilot randomized controlled trial of heparin vs saline. Cancer Nursing. 2022 Nov 1;45(6):438-46.
36. Clifton GD, Branson P, Kelly HJ, Dotson LR, Record KE, Phillips BA, Thompson JR. Comparison of normal saline and heparin solutions for maintenance of arterial catheter patency. Heart Lung. 1991 Mar;20(2):115-8. PMID: 2004920.