Background: Central venous catheters (CVCs), an important tool often utilized in the care of critically ill patients, provides access for medication and fluid administration as well as hemodynamic monitoring and diagnostics. To maintain line patency, CVCs are often flushed with unfractionated heparin (UFH) or 0.9% normal saline (NS). However, conclusive evidence surrounding the optimal CVC maintenance strategy is unknown. During a critical heparin shortage in 2019, 0.9% NS became the only CVC flush option to maintain line patency at our institution.
Aims: To compare safety and effectiveness of 0.9% NS versus UFH flush in the maintenance of CVC.
Methods: We conducted a retrospective analysis at a tertiary academic medical center of critically ill adult patients with documented CVC placed for at least 72 hours, between February 2019 and February 2020. The primary efficacy outcome was a composite of CVC occlusion, CVC removal due to thrombosis, or intracatheter alteplase administration. The secondary safety outcomes included major and clinically relevant non-major bleeding (CRNMB). Data was extracted from the electronic health record, and the results were analyzed using JMP® Pro 15 (SAS Institute Inc.) software.
Results: Five hundred consecutive patients were analyzed consisting of 250 patients in each cohort. Among the entire cohort 275 patients were male, median age was 62.2 years [51.0-72.6], median length of stay in the intensive care unit was 11 days [6.0-21.0], and the median duration of CVC was 8.3 days [5.4-13.8]. Twenty-nine patients (11.6%) in the UFH group experienced the primary outcome versus 22 patients (8.8%) in the NS group. Combined rates of major bleeding and CRNMB were similar between the two groups (6% in NS and 8% in UFH).
Conclusions: In this large retrospective analysis, there was no difference in CVC patency or bleeding events between patients who received NS versus UFH flush when used for maintenance of CVC.
To cite this abstract in AMA style:Landmesser AN, Roberts RJ, Rosovsky RP, Barra ME. Comparison of 0.9% Normal Saline (NS) Flush and Unfractionated Heparin (UFH) Flush for Maintenance of Central Venous Catheter Line Patency [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/comparison-of-0-9-normal-saline-ns-flush-and-unfractionated-heparin-ufh-flush-for-maintenance-of-central-venous-catheter-line-patency/. Accessed December 11, 2023.
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