Is Heparin Daily Flushing Useful to Decrease the Incidence of Catheter-related Infections?

Abstract

To the Editor: Central venous catheterization has complications that can interfere with the clinical course of patients. In this sense, catheter-related infection is one of the main complications. Its incidence depends on multiple associated factors such as: insertion conditions; type of catheter; insertion site; maintenance time; and daily care.1Reed CR Sessler CN Glauser FL et al.Central venous catheter infections: concepts and controversies.Intensive Care Med. 1995; 21: 177-183Crossref PubMed Scopus (91) Google Scholar It has been reported that heparin may decrease the incidence of catheter-related infectious complications, preventing the initiation and propagation of intraluminal thrombus, and therefore, bacterial colonization.2Randolph AG Cook DJ Gonzales CA et al.Benefit of heparin in central venous and pulmonary artery catheters: a meta-analysis of randomized controlled trials.Chest. 1998; 113: 165-171Abstract Full Text Full Text PDF PubMed Scopus (250) Google Scholar Nevertheless, to our knowledge, its efficacy remains doubtful, even more in children where references are scarce.3Rackoff WR Weiman M Jakobowski D et al.A randomized, controlled trial of the efficacy of a heparin and vancomycin solution in preventing central venous catheter infections in children.J Pediatr. 1995; 127: 147-151Abstract Full Text Full Text PDF PubMed Scopus (98) Google Scholar,4Smith S Dawson S Hennessey R et al.Maintenance of the patency of indwelling central venous catheters: is heparin necessary.Am J Pediatr Hematol Oncol. 1991; 13: 141-143Crossref PubMed Scopus (72) Google Scholar We have performed a prospective study with 78 consecutive children admitted to our pediatric ICU who needed a central venous access. Clinical diagnosis, purpose and type of catheter, insertion technique, site and success rate, complications, and duration were recorded for each patient. All catheters received the same daily care, but in the last 33, we added a daily heparin flushing consisting of 500 IU of unfractionated heparin diluted in 2.5 mL of normal saline solution through each lumen. Ages of patients ranged between 2 months and 14 years (mean: 6 years). Mean maintenance time was 5 ± 5.3 days (range 1–44 days). In 90% of the cases, a 2-lumen catheter was used. The access sites mainly used were internal jugular (56%) and subclavian (32%). The insertion was deemed difficult in 24 cases (31%). Both study groups (nonheparin and heparin flushing) were similar when compared in relation to the other clinical variables. The incidence of catheter-related sepsis and bacteremia in the heparin flushing group was 9% (n = 3) and in the nonheparin group was 22.2% (n = 10) (p < 0.01). Complications derived from heparin use were not found. Our results suggest that prophylactic daily flushing with heparin through the lumens of central venous catheters may have a beneficial effect in the prevention of catheter-related infectious complications. Although controversial, this practice seems easy, feasible, cost-effective, and without relevant risks.