[Effectiveness of heparin versus NaCl 0.9% in central venous catheter flushing. A systematic review]

Abstract

Objective: To determine the effects of intermittent flushing with heparin versus NaCl 0.9% solution on prevention of thrombotic events and infections in central venous catheters.

Method: A systematic review of controlled trials, randomized or not, in whose intermittent flushing with heparin versus NaCl 0.9% in central venous catheters were compared was carried out. Any publication was excluded because of patients age, country or language. Studies were identified by computerised searches (MEDLINE and CINAHL 1996-2004, EMBASE Drugs and Pharmacology 1991-2004, Cochrane Library up 2005, ISI Web of knowledge 1990-2004), clinical trials metaregister http://www. controlled-trials.commrct/mrct_info_es.asp, and scanning references.

Results: Only two clinical trials, involving 94 patients, fulfilled inclusion criteria for obstruction. Methodological quality of trials was poor and heterogenicity was also very significant. It made impossible meta-analytical combination of results. No studies comparing heparin vs. NaCl 0.9% solution flushing in catheter-related infection prophylaxis were reported.

Conclusions: Poor evidence supports effectiveness of intermittent heparin flushing vs. NaCl 0.9% solution, although methodological limitations and small sample size make these findings very inconsistent. In infection prophylaxis, there is no data allowing us to conclude if heparin flushing is more effective than NaCl 0.9% solution. More randomized clinical trials are needed.