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      Heparinized saline versus normal saline for maintaining peripheral venous catheter patency in China: An open-label, randomized controlled study

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          Abstract

          Objective

          To evaluate the effects of heparin saline versus normal saline as locking solution for maintaining patency in peripheral venous catheters in Chinese patients.

          Methods

          This open-label, randomized controlled study was conducted in two hepatobiliary surgery wards, where patients received identical treatments, at a tertiary referral hospital. Patients were randomly divided into a normal saline group (NS, 3 ml) or a heparin saline group (HS, 50 IU/ml, 3 ml) for catheter sealing.

          Results

          The study enrolled 286 patients and 609 peripheral venous catheters were included in the analysis. The patients in the two groups had no local infections or catheter-related bloodstream infections. There were no significant differences between the two groups in terms of the rate of catheter obstruction, duration time, or the rates of phlebitis, infiltration, and accidental catheter removal.

          Conclusions

          No significant differences in the peripheral venous catheter sealing effects were observed between normal saline and heparin saline usage in Chinese patients.

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          Most cited references26

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          Peripheral venous catheters: an under-evaluated problem.

          Peripheral venous catheters (PVC) are the most frequently used invasive devices in hospitals. Up to 70% of patients require a peripheral venous line during their hospital stay, and conservative estimates suggest that PVC days account for 15-20% of total patient days in acute care hospitals. Most published studies focus on thrombophlebitis and address the issue of scheduled catheter change, but there is still no consensus on the optimal time point for PVC change, or whether catheter replacement is required at all. Although PVC-associated catheter-related bloodstream infections (PVC-BSI) are far more serious than thrombophlebitis, few studies address this issue, and a large multicentre trial is lacking. Some studies on thrombophlebitis mention that no, or only a few, PVC-BSIs were identified, but such results must be interpreted with caution. Current data available on PVC-BSI suggest incidence density rates of 0.2-0.7 episodes per 1000 device days, which appear low when compared with other catheters. However, some studies report absolute PVC-BSI numbers in the range of central line-associated infections. It remains unclear whether PVC-BSI should be considered a serious healthcare problem or simply a very rare event. More research is needed both to capture the dimension of the problem and to provide efficient control measures.
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            Routine resite of peripheral intravenous devices every 3 days did not reduce complications compared with clinically indicated resite: a randomised controlled trial

            Background Peripheral intravenous device (IVD) complications were traditionally thought to be reduced by limiting dwell time. Current recommendations are to resite IVDs by 96 hours with the exception of children and patients with poor veins. Recent evidence suggests routine resite is unnecessary, at least if devices are inserted by a specialised IV team. The aim of this study was to compare the impact of peripheral IVD 'routine resite' with 'removal on clinical indication' on IVD complications in a general hospital without an IV team. Methods A randomised, controlled trial was conducted in a regional teaching hospital. After ethics approval, 362 patients (603 IVDs) were randomised to have IVDs replaced on clinical indication (185 patients) or routine change every 3 days (177 patients). IVDs were inserted and managed by the general hospital medical and nursing staff; there was no IV team. The primary endpoint was a composite of IVD complications: phlebitis, infiltration, occlusion, accidental removal, local infection, and device-related bloodstream infection. Results IVD complication rates were 68 per 1,000 IVD days (clinically indicated) and 66 per 1,000 IVD days (routine replacement) (P = 0.86; HR 1.03; 95% CI, 0.74-1.43). Time to first complication per patient did not differ between groups (KM with log rank, P = 0.53). There were no local infections or IVD-related bloodstream infections in either group. IV therapy duration did not differ between groups (P = 0.22), but more (P = 0.004) IVDs were placed per patient in the routine replacement (mean, 1.8) than the clinical indication group (mean, 1.5), with significantly higher hospital costs per patient (P < 0.001). Conclusions Resite on clinical indication would allow one in two patients to have a single cannula per course of IV treatment, as opposed to one in five patients managed with routine resite; overall complication rates appear similar. Clinically indicated resite would achieve savings in equipment, staff time and patient discomfort. There is growing evidence to support the extended use of peripheral IVDs with removal only on clinical indication. Registration number Australian New Zealand Clinical Trials Registry (ANZCTR) Number ACTRN12608000421336.
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              Intermittent flushing with heparin versus saline for maintenance of peripheral intravenous catheters in a medical department: a pragmatic cluster-randomized controlled study.

              Three meta-analyses conducted in the 1990s concluded that the effect of intermittent flushing with heparin at low concentration (10 U/mL) was equivalent to that of 0.9% sodium chloride flushes in preventing occlusion or superficial phlebitis. No firm conclusion was reached on the safety and efficacy of heparin concentrations of 100 U/mL used as an intermittent flush.
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                Author and article information

                Journal
                J Int Med Res
                J. Int. Med. Res
                IMR
                spimr
                The Journal of International Medical Research
                SAGE Publications (Sage UK: London, England )
                0300-0605
                1473-2300
                30 January 2017
                April 2017
                : 45
                : 2
                : 471-480
                Affiliations
                [1 ]School of Nursing, Fudan University, Shanghai, China
                [2 ]Department of Vascular Surgery, Zhongshan Hospital Affiliated to Xiamen University, Xiamen, Fujian Province, China
                [3 ]Department of Hospital Infection Control, Zhongshan Hospital Affiliated to Xiamen University, Xiamen, Fujian Province, China
                [4 ]Department of Nursing, Zhongshan Hospital Affiliated to Xiamen University, Xiamen, Fujian Province, China
                Author notes
                [*]Yan Hu, School of Nursing, Fudan University, 305 Fenglin Road, Shanghai 200032, China. Email: huyan@ 123456fudan.edu.cn
                Article
                10.1177_0300060516685203
                10.1177/0300060516685203
                5536662
                28415937
                27b6ed44-234c-4f79-abd2-d014616a265c
                © The Author(s) 2017

                This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 3.0 License ( http://www.creativecommons.org/licenses/by-nc/3.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                History
                : 15 July 2016
                : 29 November 2016
                Categories
                Research Reports

                heparin,peripheral venous catheter,catheter flushing,heparinized saline

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