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Abstract
Thrombotic occlusion is frequently a complication of central venous catheters (CVCs).
The original designers and producers of CVCs recommended heparin flush regimens to
prevent thrombosis and maintain patency. This has become standard practice although
no studies have demonstrated a relationship between heparin flushing and reduction
of catheter thrombosis. Many consider the routine use of heparin flushing innocuous.
However, serious complications including drug interactions and heparin induced thrombocytopenia
and thrombosis syndrome (HITS) have been reported in association with heparin flushing.
Numerous studies comparing heparin to saline flushing in peripheral devices suggest
equal rates of thrombotic occlusions. The purpose of this study was to examine the
incidence of thrombotic occlusions in CVCs using heparin compared to saline flushing.
The study involved 78 cancer patients undergoing apheresis collection for peripheral
blood stem cells; 29 received saline flushes and 49 received heparin (100 U/ml of
saline) flushes. Study endpoints included slow apheresis flow rate (< 50 ml/min),
urokinase use for thrombolysis, and radiographic evidence of catheter thrombosis.
No significant differences were found for any endpoint between the two groups. These
findings suggest saline may be as effective as heparin for maintaining patency of
CVCs.