Randomized clinical trial analyzing maintenance of peripheral venous catheters in an internal medicine unit: Heparin vs. saline


Autoři: María Jesús Pérez-Granda aff001;  Emilio Bouza aff003;  Blanca Pinilla aff005;  Raquel Cruces aff001;  Ariana González aff007;  Jesús Millán aff006;  María Guembe aff001
Působiště autorů: Department of Clinical Microbiology and Infectious Diseases, H.G.U. Gregorio Marañón, Madrid, Spain aff001;  Department of Nursing, School of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, Madrid, Spain aff002;  CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain aff003;  Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain aff004;  Infection Study Group of the Sociedad Española de Medicina Interna, Madrid, Spain aff005;  Department of Internal Medicine, H.G.U. Gregorio Marañón, Madrid, Spain aff006;  Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain aff007
Vyšlo v časopise: PLoS ONE 15(1)
Kategorie: Research Article
doi: 10.1371/journal.pone.0226251

Souhrn

Background

Peripheral venous catheters (PVCs) require adequate maintenance based on heparin or saline locks in order to prevent complications. Heparin has proven effective in central venous catheters, although its use in PVCs remains controversial. Our hypothesis was that saline locks are as effective as heparin locks in preventing problems with PVCs. The objective of the present study was to compare phlebitis and catheter tip colonization rates between PVCs locked with saline and those locked with heparin in patients admitted to an internal medicine department (IMD).

Methods

We performed a 19-month prospective, controlled, open-label, randomized clinical study of patients with at least 1 PVC admitted to the IMD of our hospital. The patients were randomized to receive saline solution (PosiFlush®, group A) or heparin (Fibrilin®, group B) for daily maintenance of the PVC. Clinical and microbiological data were monitored to investigate the frequency of phlebitis, catheter tip colonization, and catheter-related bloodstream infection (C-RBSI), as well as crude mortality, days of hospital stay, and days of antimicrobial treatment.

Results

We assessed 339 PVCs (241 patients), of which 192 (56.6%) were locked with saline (group A) and 147 (43.4%) with heparin (group B). The main demographic characteristics of the patients were distributed equally between the 2 study groups. The median (IQR) catheter days was 5 (3–8) for both groups (p = 0.64). The frequency of phlebitis was 17.7% for group A and 13.3% for group B (p = 0.30). The frequency of colonization of PVC tips was 14.6% and 12.2% in groups A and B, respectively (p = 0.63). Only 2 episodes of C-RBSI were detected (1 patient in group A). Saline lock was not an independent factor for phlebitis or catheter colonization.

Conclusions

Our study revealed no statistically significant differences in the frequency of phlebitis and catheter tip colonization between PVCs locked with saline and PVCs locked with heparin. We suggest that PVC can be maintained with saline solution, as it is safer and cheaper than heparin.

Klíčová slova:

Bloodstream infections – Catheters – Critical care and emergency medicine – Death rates – Heparin – Hospitals – Polyvinyl chloride – Regression analysis


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Článek vyšel v časopise

PLOS One


2020 Číslo 1