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heparin vs saline in PICCs

Any good articles out there about clot incidence using saline vs heparin in PICC lines

1.    Bowers L, Speroni K,

1.    Bowers L, Speroni K, Jones L, Atherton M. Comparison of occlusion rates by flushing solutions for peripherally inserted central catheters with positive pressure luer-activated devices. Journal of Infusion Nursing. 2008;31(1):22-27.
A small but randomized clinical trial. They stated with heparin.

2.    Cesaro S, Tridello G, Cavaliere M, et al. Prospective, randomized trial of two different modalities of flushing central venous catheters in pediatric patients with cancer. J Clin Oncol. Apr 20 2009;27(12):2059-2065.
Large RCT with tunneled caths in peds. Occlusion and infection was doubled with saline only and a positive displacement mechanical valve needleless connector

3.    Mitchell M, Anderson B, Williams K, Umscheid C. Heparin flushing and other interventions to maintain patency of central venous catheters: a systematic review. Journal of Advanced Nursing. 2009;65(10):2007-2021.
A systematic lit review showing lack of adequate studies to make a recommendation.

My recommendation based on these studies - it is premature to abandon heparin lock solution for all types of CVCs. We simply do not have enough information and the risk and cost of managing occlusion and infection in CVCs is far too great to rely on saline only. Lynn

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

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