Abstract
BackgroundThe purpose of this study was to determine whether heparinized saline (HS) would be more effective in maintaining the patency of central venous catheters (CVCs) in dogs compared to 0.9% sodium chloride. This was a prospective randomized blinded study conducted at a University Veterinary Teaching Hospital.MethodsA total of 24 healthy purpose-bred dogs were randomized into two groups: a treatment and a control group. A CVC was placed in the jugular vein of each dog. Each dog in the treatment group had their CVC flushed with 10 IU/mL HS, while dogs in the control group had their CVC flushed with 0.9% sodium chloride every 6 h for 72 h. Immediately prior to flushing, each catheter was evaluated for patency by aspiration of blood. The catheter site was also evaluated for phlebitis, and a rectal temperature was obtained in each dog every 6 h. Prothrombin (PT) and activated partial thromboplastin (aPTT) times were evaluated prior to the administration of any flush solution. Results were then compared to values obtained 72 h later.ResultsAll CVCs in both groups were patent after 72 h, which was demonstrated by aspiration of blood and ease of flushing the catheter. Two CVCs in the 0.9% sodium chloride group had a negative aspiration at hour 12 and 36, respectively. One CVC in the HS group had a negative aspiration at hour 18. Signs of phlebitis occurred in three dog: two in the 0.9% sodium chloride group and one in the HS group. No dog was hyperthermic (>103 °F). Two catheters were inadvertently removed by dogs in the HS group during the study. There were no significant differences in catheter patency, incidence of phlebitis, or incidence of negative aspirations between both groups. aPTT and PT values remained within the normal reference range for all dogs in both groups. Ultimately, 0.9% sodium chloride was as effective as 10 IU/mL HS in maintaining the patency of CVCs for up to 72 h in healthy dogs. Further evaluation in clinical patients is warranted.
Highlights
Complications associated with indwelling central venous catheters (CVCs) include phlebitis, occlusion, infection at the catheter site, catheter related blood stream infection, and thrombosis (Parienti et al, 2015)
A total of 12 dogs were randomly assigned to the S group, consisting of four intact males and eight intact females while 12 dogs were assigned to the heparinized saline (HS) group, consisting of five intact males, and seven intact females
Despite the overwhelming evidence in human patients showing that 0.9% sodium chloride is an effective flushing solution to maintain CVC patency (Bradford, Edwards & Chan, 2015, 2016; Heidari Gorji et al, 2015; LeDuc, 1997; Ziyaeifard et al, 2015), HS is still used in many veterinary facilities (Fleeman, 2001)
Summary
Central venous catheterization was first performed in 1929 and has become a mainstay of modern clinical practice (Smith & Nolan, 2013).They are indispensable devices utilized in both human and veterinary medicine to deliver intermittent medications, continuous intravenous infusions, obtain serial blood draws, provide parental nutrition, aid in hemodynamic monitoring and interventions, and provide access for extracorporeal blood circuits (Elliott, Fleeman & Rand, 2010; Smith & Nolan, 2013; Tan, Dart & Dowling, 2003; Ueda, Odunayo & Mann, 2013).Complications associated with indwelling central venous catheters (CVCs) include phlebitis, occlusion, infection at the catheter site, catheter related blood stream infection, and thrombosis (Parienti et al, 2015). The purpose of this study was to determine whether heparinized saline (HS) would be more effective in maintaining the patency of central venous catheters (CVCs) in dogs compared to 0.9% sodium chloride. This was a prospective randomized blinded study conducted at a University Veterinary Teaching Hospital. Prior to flushing, each catheter was evaluated for patency by aspiration of blood. Results: All CVCs in both groups were patent after 72 h, which was demonstrated by aspiration of blood and ease of flushing the catheter. 0.9% sodium chloride was as effective as 10 IU/mL HS in maintaining the patency of CVCs for up to 72 h in healthy dogs.
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