PB0255 - Efficacy of normal saline versus heparin locking in the prevention of non-valved peripherally inserted central catheter associated complications: a systematic review

Sunday, July 10, 2022

6:30 PM – 7:30 PM

Location: Exhibition

Presentation Format: In-Person

Presenting Author(s)

Sajjad Afraz, MD, MASc

Resident Physician
University of Texas Southwestern Medical Center
Dallas, Texas, United States

Co-Author(s)

GZ

George Zhao

Medical Student
University of Toronto
Toronto, Ontario, Canada
PT

Paul Tieu

Graduate Student
Thrombosis & Atherosclerosis Research Institute, McMaster University, Hamilton, Canada
Hamilton, Ontario, Canada
MB

Mihir D. Bhatt, MD

Pediatric Hematologist
McMaster Children’s Hospital
Hamilton, Ontario, Canada
NS

Nasrin Samji

Assistant Professor, Pediatrics
McMaster Children’s Hospital, Hamilton, Canada
Hamilton, Ontario, Canada
JD

John Donnellan

Pediatric Interventional Radiologist
McMaster Children’s Hospital
Hamilton, Ontario, Canada
Anthony K. Chan, MBBS, FRCP (C), MBBS

Pediatric Hematologist
Department of Pediatrics, McMaster Children's Hospital
Hamilton, Ontario, Canada

Background: Varying types of peripherally inserted central catheters (PICCs) are widely used. Cuffed, non-valved PICCs (NVPICCs) are preferred type of PICCs for pediatric patients in our institution due to less risk of line displacement and fewer associated complications. Intermittent locking of PICCs with either heparin or normal saline (NS) is required to maintain its patency. Catheter maintenance practice varies among institutions, and NVPICCs require daily heparin flush per our institution policy. However, the use of heparin is questionable, as it is costly and is not risk-free particularly in pediatrics.

Aims: To compare the effectiveness of NS versus heparin in prevention of complications associated with NVPICCs

Methods: A systematic literature review was conducted using PubMed, MEDLINE, EMBASE and Cochrane library (Figure.1). Studies reporting use of NS or heparin lock/flush for NVPICCs in adult or pediatric patients that investigated catheter-associated complications were included. The primary and secondary outcomes were rates of all-cause complications and premature catheter removal, respectively.

Results: Systematic search retrieved 335 unique articles. After abstract and full text screening, 7 studies were included (Table.1). Six trials involved adults and one involved neonates. Four studies utilized NS and 3 used heparin as locking solution. No studies directly compared the efficacy of NS versus heparin in NVPICCs. Although NS was associated with higher complication rate per line compared to heparin (21.3% vs. 13.5%), overall rate of complication per catheter-days and premature removal were lower with NS (1.3 vs. 5.3 per 1000 catheter-days and 5.5% vs. 11.3%, respectively).

Conclusion(s): Evaluation of 7 heterogenous studies did not show inferiority of NS compared to heparin with regards to prevention of complications associated with NVPICCs. There is a need for a randomized controlled trial to specifically assess the efficacy of NS versus heparin in NVPICCs in pediatric patients.