Why are heparin flushes no longer used

Background: Patients undergoing blood and marrow transplantation (BMT) use a central venous catheter (CVC); heparin is often employed to maintain patency but may increase the risk of complications. Research has not provided conclusive differences in efficacy and safety regarding heparin flushing versus normal saline flushing in CVC maintenance. Minimal research is specific to this patient population.

Objectives: This study aimed to determine if differences exist in CVC patency, tissue plasminogen activator usage, and the incidence of central line–associated bloodstream infections when flushing with normal saline only versus heparin and normal saline among patients undergoing BMT.

Methods: A convenience sample of 30 patients undergoing allogeneic or autologous transplantation with a new non-port/non–peripherally inserted CVC were evaluated.

Findings: Elimination of routine heparin use could positively affect outcomes in this patient population.

Not a current ONS member or journal subscriber?

The study team will be performing a study comparing the use of Heparin Flushes vs. Normal Saline Flushes in making sure central lines stay open. The participants will be placed in a group to receive the University of Texas Southwestern Medical Center (UTSW) Standard of Care (control group) for maintaining central lines, or a group to receive Normal Saline Flushes only (experimental group) to keep their central line open. The participants electronic medical record will be reviewed by study team members for the inclusion/exclusion criteria, the participants central line will be assessed by an 11 Blue BMT nurse every 12 hours, and they may be asked questions regarding their medical history during their stay on 11 Blue BMT. If a participant is discharged or transferred off of the 11 Blue BMT unit, they will no longer be included in the study and their central line maintenance will return to the UTSW Standard of Care. Participants in this study may be at risk for central line occlusion (a blood clot) which could require intervention to regain the free flow of fluids and use of the central line. The study team predicts there will be no increase in the rate of line occlusion when using Normal Saline Flushes only to maintain the free flow of fluids through participants central line. The study team also hopes the results of this study will help to improve patient outcomes by decreasing risk of infection, heparin associated complications, and costs.

Primary Outcome Measures :

1. Patency [ Time Frame: Up to Day 7 of enrollment ]

   To determine whether or not flushing central lines with normal saline only will maintain free flow through these central lines.

   
   

Secondary Outcome Measures :

1. Infection Rate [ Time Frame: From Day 1 and up to Day 7 of enrollment ]

   To determine whether or not removing Heparin Flushes from PICC line maintenance decreases the risk for central line associated infections

   
   

Inclusion Criteria:

• Oncology patients
• Admitted to 11Blue Bone Marrow Transplant Unit at Clements University Hospital University of Texas Southwestern Medical Center
• Ages 18-80 years
• Pre-existing or newly placed PICC line
• PICC line with good blood return (defined as: "brisk blood return of 3cc")
• Flushes without difficulty

Exclusion Criteria:

• Patient less than 18 years of age or greater than 80 years of age
• Refused or unable to give consent to the study
• Patient admitted to the 11Blue BMT unit with any line other than a PICC line, or multiple lines
• Patient admitted to 11Blue BMT for active transplant
• Patient with a coagulopathy diagnosis
• Patient on therapeutic dose of anticoagulants for documented Deep Vein Thrombosis or Pulmonary Embolism
• Patient on inpatient hospice/comfort care
• Patient transferred off 11B BMT unit onto another floor

University of Texas Southwestern Medical Center

Keywords provided by Meredith Allen, University of Texas Southwestern Medical Center:

Additional relevant MeSH terms: