Randomized clinical trial analyzing maintenance of peripheral venous catheters in an internal medicine unit: Heparin vs. saline
Autoři:
María Jesús Pérez-Granda aff001; Emilio Bouza aff003; Blanca Pinilla aff005; Raquel Cruces aff001; Ariana González aff007; Jesús Millán aff006; María Guembe aff001
Působiště autorů:
Department of Clinical Microbiology and Infectious Diseases, H.G.U. Gregorio Marañón, Madrid, Spain
aff001; Department of Nursing, School of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, Madrid, Spain
aff002; CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain
aff003; Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
aff004; Infection Study Group of the Sociedad Española de Medicina Interna, Madrid, Spain
aff005; Department of Internal Medicine, H.G.U. Gregorio Marañón, Madrid, Spain
aff006; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
aff007
Vyšlo v časopise:
PLoS ONE 15(1)
Kategorie:
Research Article
prolekare.web.journal.doi_sk:
https://doi.org/10.1371/journal.pone.0226251
Souhrn
Background
Peripheral venous catheters (PVCs) require adequate maintenance based on heparin or saline locks in order to prevent complications. Heparin has proven effective in central venous catheters, although its use in PVCs remains controversial. Our hypothesis was that saline locks are as effective as heparin locks in preventing problems with PVCs. The objective of the present study was to compare phlebitis and catheter tip colonization rates between PVCs locked with saline and those locked with heparin in patients admitted to an internal medicine department (IMD).
Methods
We performed a 19-month prospective, controlled, open-label, randomized clinical study of patients with at least 1 PVC admitted to the IMD of our hospital. The patients were randomized to receive saline solution (PosiFlush®, group A) or heparin (Fibrilin®, group B) for daily maintenance of the PVC. Clinical and microbiological data were monitored to investigate the frequency of phlebitis, catheter tip colonization, and catheter-related bloodstream infection (C-RBSI), as well as crude mortality, days of hospital stay, and days of antimicrobial treatment.
Results
We assessed 339 PVCs (241 patients), of which 192 (56.6%) were locked with saline (group A) and 147 (43.4%) with heparin (group B). The main demographic characteristics of the patients were distributed equally between the 2 study groups. The median (IQR) catheter days was 5 (3–8) for both groups (p = 0.64). The frequency of phlebitis was 17.7% for group A and 13.3% for group B (p = 0.30). The frequency of colonization of PVC tips was 14.6% and 12.2% in groups A and B, respectively (p = 0.63). Only 2 episodes of C-RBSI were detected (1 patient in group A). Saline lock was not an independent factor for phlebitis or catheter colonization.
Conclusions
Our study revealed no statistically significant differences in the frequency of phlebitis and catheter tip colonization between PVCs locked with saline and PVCs locked with heparin. We suggest that PVC can be maintained with saline solution, as it is safer and cheaper than heparin.
Klíčová slova:
Death rates – Critical care and emergency medicine – Hospitals – Catheters – Regression analysis – Heparin – Polyvinyl chloride – Bloodstream infections
Zdroje
1. Perez-Granda MJ, Guembe MR, Rincon C, Munoz P, Bouza E (2014) A prevalence survey of intravascular catheter use in a general hospital. J Vasc Access 15: 524–528. doi: 10.5301/jva.5000272 25041909
2. Zingg W, Pittet D (2009) Peripheral venous catheters: an under-evaluated problem. Int J Antimicrob Agents 34 Suppl 4: S38–42.
3. Mattox EA (2017) Complications of Peripheral Venous Access Devices: Prevention, Detection, and Recovery Strategies. Crit Care Nurse 37: e1–e14.
4. Alexandrou E, Ray-Barruel G, Carr PJ, Frost SA, Inwood S, Higgins N. et al. (2018) Use of Short Peripheral Intravenous Catheters: Characteristics, Management, and Outcomes Worldwide. J Hosp Med 13.
5. Capdevila-Reniu A, Capdevila JA (2017) Peripheral venous catheter, a dangerous weapon. Key points to improve its use. Rev Clin Esp 217: 464–467. doi: 10.1016/j.rce.2017.04.001 28576382
6. Delgado-Capel M, Gabillo A, Elias L, Yebenes JC, Sauca G, Capdevila J. A. (2012) [Peripheral venous catheter-related bacteremia in a general hospital]. Rev Esp Quimioter 25: 129–133. 22707101
7. Rickard CM, Ray-Barruel G (2017) Peripheral intravenous catheter assessment: beyond phlebitis. Lancet Haematol 4: e402–e403. doi: 10.1016/S2352-3026(17)30145-X 28863798
8. Guembe M, Perez-Granda MJ, Capdevila JA, Barberan J, Pinilla B, Bouza E. (2018) Impact of a training program on adherence to recommendations for care of venous lines in internal medicine departments in Spain. Eur J Clin Microbiol Infect Dis 37: 1163–1168. doi: 10.1007/s10096-018-3236-4 29569044
9. Zhong L, Wang HL, Xu B, Yuan Y, Wang X, Zhang Y. Y. et al. (2017) Normal saline versus heparin for patency of central venous catheters in adult patients—a systematic review and meta-analysis. Crit Care 21: 5. doi: 10.1186/s13054-016-1585-x 28063456
10. Xu L, Hu Y, Huang X, Fu J, Zhang J (2017) Heparinized saline versus normal saline for maintaining peripheral venous catheter patency in China: An open-label, randomized controlled study. J Int Med Res 45: 471–480. doi: 10.1177/0300060516685203 28415937
11. Wang R, Zhang MG, Luo O, He L, Li JX, Tang Y. J.,et al. (2015) Heparin Saline Versus Normal Saline for Flushing and Locking Peripheral Venous Catheters in Decompensated Liver Cirrhosis Patients: A Randomized Controlled Trial. Medicine (Baltimore) 94: e1292.
12. Keogh S, Flynn J, Marsh N, Higgins N, Davies K, Rickard C. M. (2015) Nursing and midwifery practice for maintenance of vascular access device patency. A cross-sectional survey. Int J Nurs Stud 52: 1678–1685. doi: 10.1016/j.ijnurstu.2015.07.001 26206327
13. Bertolino G, Pitassi A, Tinelli C, Staniscia A, Guglielmana B, Scudeller L, et al. (2012) 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 9: 221–226. doi: 10.1111/j.1741-6787.2012.00244.x 22390572
14. Keogh S, Flynn J, Marsh N, Mihala G, Davies K, Rickard C. (2016) Varied flushing frequency and volume to prevent peripheral intravenous catheter failure: a pilot, factorial randomised controlled trial in adult medical-surgical hospital patients. Trials 17: 348. doi: 10.1186/s13063-016-1470-6 27456005
15. Goossens GA (2015) Flushing and Locking of Venous Catheters: Available Evidence and Evidence Deficit. Nurs Res Pract 2015: 985686. doi: 10.1155/2015/985686 26075094
16. Gunes A, Bramhagen AC (2018) Heparin or Sodium Chloride for Prolonging Peripheral Intravenous Catheter Use in Children—A Systematic Review. J Pediatr Nurs.
17. Capdevila JA, Guembe M, Barberan J, de Alarcon A, Bouza E, Farinas M. C, et al. (2016) 2016 Expert consensus document on prevention, diagnosis and treatment of short-term peripheral venous catheter-related infections in adult. Rev Esp Quimioter 29: 230–238. 27580009
18. Miller DL, O'Grady NP (2012) Guidelines for the prevention of intravascular catheter-related infections: recommendations relevant to interventional radiology for venous catheter placement and maintenance. J Vasc Interv Radiol 23: 997–1007. doi: 10.1016/j.jvir.2012.04.023 22840801
19. Marschall J, Mermel LA, Fakih M, Hadaway L, Kallen A, O'Grady N. P, et al. (2014) Strategies to prevent central line-associated bloodstream infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol 35: 753–771. doi: 10.1086/676533 24915204
20. Rickard C (2016) BJN Awards 2016: IV therapy. Br J Nurs 25: S33–34. doi: 10.12968/bjon.2016.25.14.S33 27467655
21. Manian FA (2009) IDSA guidelines for the diagnosis and management of intravascular catheter-related bloodstream infection. Clin Infect Dis 49: 1770–1771; author reply 1771–1772. doi: 10.1086/648113 19891568
22. You T, Jiang J, Chen J, Xu W, Xiang L, Jiao Y. (2017) Necessity of heparin for maintaining peripheral venous catheters: A systematic review and meta-analysis. Exp Ther Med 14: 1675–1684. doi: 10.3892/etm.2017.4706 28810636
23. Upadhyay A, Verma KK, Lal P, Chawla D, Sreenivas V (2015) Heparin for prolonging peripheral intravenous catheter use in neonates: a randomized controlled trial. J Perinatol 35: 274–277. doi: 10.1038/jp.2014.203 25474552
24. Guembe M, Perez-Granda MJ, Capdevila JA, Barberan J, Pinilla B, Martin-Rabadan P, et al. (2017) Nationwide study on peripheral-venous-catheter-associated-bloodstream infections in internal medicine departments. J Hosp Infect 97: 260–266. doi: 10.1016/j.jhin.2017.07.008 28716670
25. Mihala G, Ray-Barruel G, Chopra V, Webster J, Wallis M, Marsh N, et al. (2018) Phlebitis Signs and Symptoms With Peripheral Intravenous Catheters: Incidence and Correlation Study. J Infus Nurs 41: 260–263. doi: 10.1097/NAN.0000000000000288 29958263
26. Hawkins T, Greenslade JH, Suna J, Williams J, Rickard CM, Jensen M, et al. (2018) Peripheral Intravenous Cannula Insertion and Use in the Emergency Department: An Intervention Study. Acad Emerg Med 25: 26–32. doi: 10.1111/acem.13335 29044739
27. Guihard B, Rouyer F, Serrano D, Sudrial J, Combes X (2018) Appropriateness and Complications of Peripheral Venous Catheters Placed in an Emergency Department. J Emerg Med 54: 281–286. doi: 10.1016/j.jemermed.2017.10.005 29217204
28. Roszell SS, Rabinovich HB, Smith-Miller CA (2018) Maintaining Short Peripheral Catheter Patency: A Comparison of Saline Lock Versus Continuous Infusion in the Acute Care Setting. J Infus Nurs 41: 165–169. doi: 10.1097/NAN.0000000000000276 29659463
Článok vyšiel v časopise
PLOS One
2020 Číslo 1
- Metamizol jako analgetikum první volby: kdy, pro koho, jak a proč?
- Parazitičtí červi v terapii Crohnovy choroby a dalších zánětlivých autoimunitních onemocnění
- Nejasný stín na plicích – kazuistika
- Masturbační chování žen v ČR − dotazníková studie
- Eliquis (apixaban) nově hrazen ze zdravotního pojištění
Najčítanejšie v tomto čísle
- Psychometric validation of Czech version of the Sport Motivation Scale
- Comparison of Monocyte Distribution Width (MDW) and Procalcitonin for early recognition of sepsis
- Effects of supplemental creatine and guanidinoacetic acid on spatial memory and the brain of weaned Yucatan miniature pigs
- Accelerated sparsity based reconstruction of compressively sensed multichannel EEG signals