I have always been sceptical of using saline alone for flushing and locking central venous catheters, but until now the evidence has been very limited. While searching the literature for a new research  about heparin, which really impressed me!

Cesaro, et.al  conducted a randomized trial in children with cancer and newly inserted tunneled, cuffed catheters. They compared one cohort with heparin flushing and a standard cap (their term) to saline only flushing with a positive displacement needleless connector. There were 203 patients and more than 75,000 catheter days. The experimental cohort has twice the rate of occlusion and almost triple the rate of bacteremia.

There has been a small study of a similar type in patients with PICCs. Bowers, et.al found a 6% occlusion rate with saline only flushing and a positive displacement needleless connector. This rate was not statistically significant, possible because the study had only 102 patients. The authors went on to quantify the cost of declotting 6% of their PICCs annually and reported that even this small number was too costly. In Fact, There were no occlusions in the 52 subjects randomly assigned to the heparinized saline group. Although the occlusion rate findings were not statistically significant, the charges associated with replacing a PICC because of occlusion are economically relevant. The annualized savings attributable to heparinized saline use are $22,891.

Evidence is growing that saline alone is not sufficient for locking any central venous catheter. I know there are numerous issues with heparin and we need alternatives, but there is no alternative locking solution that has been cleared for market by NICE or BNF at this time. So we keep waiting and using heparin or obtain one of the alternative solutions from a local compounding pharmacy. Neither are good options, but those are the only choices currently. I would encourage everyone to obtain and read these recent articles and apply them to your evidence-based practice. Click on the highlighted authors name above to get to the reference information and abstract.

References

1. 1)Cusinato R, Zadra N, Franco Zanon G, Zanesco L, Carli M.(2009)Prospective, randomized trial of two different modalities of flushing central venous catheters in pediatric patients with cancer .J Clin Oncol. Apr 20;27(12):2059-65.
   

2. 2)Bowers L, Speroni KG, Jones L, Atherton M (2008).Comparison of occlusion rates by flushing solutions for peripherally inserted central catheters with positive pressure Luer-activated devices.J Infus Nurs. 2008Jan-Feb;31(1):22-7.
   

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