ºÚÁϳԹÏÍø

Home⇛The PCMC Journal⇛vol. 17 no. 1 (2021)

Impact of Low-Dose Heparin on Duration of Peripherally inserted Central Catheter at the Neonatal Intensive Care Unit: A Meta-Analysis

Ma. Leah Pamela W. Ilagan | Genevieve A Abuan | Sharlene S Seng

Discipline: medicine by specialism

 

Abstract:

OBJECTIVES: To determine efficacy of continuous heparin infusion vs placebo on maintenance of peripherally inserted central catheter line among neonates admitted at the NICU. METHODS: This is a meta-analysis of randomized controlled trials reported in accordance with PRISMA checklist. Cochrane Risk-of-bias tool was used in assessment of reporting biases. Pooled risk ratios were estimated using random- or fixed-effects model. RESULTS: Of 4519 studies identified, 4 studies were included, and all have low risk of bias. Meta-analysis showed that continuous heparin infusion on PICCs had significantly higher duration of catheter patency compared to the placebo group (MD=2.22, 95%CI=1.03-3.14, p-value<0.00001). Heparin group also had decreased risk of occlusion (RR=0.47, 95%CI=0.94, p-values=0.03) compared to control. The risk for other adverse events such as thrombosis, infection, IVH progression, and mortality was comparable between the two groups. CONCLUSION: Continuous heparin infusion in PICC fluids can prolong duration of catheter patency by 2.2 days and reduce risk of catheter-related occlusion by 50%, without having significant effect on incidence of other adverse events. RECOMMENDATIONS: Continuous heparin infusion on PICC fluids should be part of maintenance and care policy at the NICU, but precautions should be followed to prevent adverse outcomes. Systematic review of intermittent heparin flushing can be a window of opportunity.



References:

  1. Petit, J. Highes, K. Neonatal intravenous therapy practices. Journal of Vascular Access. January 1999;4(1):7-16.
  2. Ismail, M. Study of Different neonatal vascular accesses in neonatal intensive care units in different universities hospitals in Egypt. Al-Azhar Assiut Medical Journal. April 2015;(13)2.
  3. Ainsworth S., McGuire, W. Peripherally inserted central catheters vs peripheral cannulas for delivering parenteral nutrition in neonates. Journal of the American Medical Association. 2016;315(23):2612-2613.
  4. Legemaat, M., etal. Peripheral intravenous cannulation: Complication rates in the neonatal population: A multicenter observational study. Journal of Vascular Access. 2016;17(4):360-365.
  5. McCay, A., Elliott, E. Videos in clinical medicine. PICC placement in the neonate. The New England Journal of Medicine. 2014:370(1).
  6. Colacchio, K. etal., Complications associated with central and non-central venous catheters in a neonatal intensive care unit. Journal of Perinatology. 2012;32(12):941-946.
  7. Jain, A., etal., Peripherally inserted central catheter tip position and risk of associated complications in neonates. Journal of Perinatology. 2013;33(4):307-312.
  8. Mahieu, L., etal. Risk factors for central vascular catheter-associated bloodstream infections among patients in a neonatal intensive care unit. Journal of Hospital Infection. 2001;48:108-16.
  9. You, Y. etal. Necessity of heparin for maintaining peripheral venous catheters: A systematic review and meta-analysis. Experimental and Therapeutic Medicine. 2017 Aug;14(2):1675-1684.
  10. Ahmed, I., etal. Heparin induced thrombocytopenia: Diagnosis and management update. Postgrad Medical Journal. 2007;83:575-582.
  11. Moclair, A., Bates, I. The efficacy of heparin in maintaining peripheral infusion in neonates. European Journal of Pediatrics. 1995;154:567-70.
  12. Alpan, G. etal. Heparinization of alimentation solutions administered through peripheral veins in premature infants: A controlled study. Pediatrics. 1984;74:375-8.
  13. Randolph, A. etal. Benefit of heparin in peripheral venous and arterial catheters: systematic review and meta-analysis of randomized controlled trials. British Medical Journal. 1998;316:969-75.
  14. Kamala, F., etal. Randomized controlled trial of heparin for prevention of blockage of peripherally inserted central catheters in neonates. Acta Paediatrica. June 2020;91.
  15. Sharma, S. etal. Heparin flush vs normal saline flush to maintain patency of central venous catheter among adult patients: A systematic review and meta-analysis. Journal of Family Medicine and Primary Care. September 2019;8(9):2779-2792.
  16. Rabe, C. etal., Keeping central venous lines open: A prospective comparison of heparin, vitamin C and sodium chloride sealing solutions in medical patients. Intensive Care Med. 2002;28:1172-6.
  17. Beigi, AK., etal., Heparin compared with normal saline to maintain patency of permanent double lumen hemodialysis catheters: A randomized controlled trial. Advance Biomedical Research. 2014;3:121.
  18. HeidariGorji, MA., etal., Comparison of the effects of heparin and 0.9% sodium chloride solutions in maintenance of patency of central venous catheters. Anesth Pain Med. 2015:5.
  19. Shah PS, Kalyn A, Satodia P, et al. A randomized, controlled trial of heparin versus placebo infusion to prolong the usability of peripherally placed percutaneous central venous catheters (PCVCs) in neonates: the HIP (Heparin Infusion for PCVC) study. Pediatrics. 2007;119(1):e284-e291. doi:10.1542/peds.2006-0529
  20. Uslu S, Ozdemir H, Comert S, etal., The effect of low-dose heparin on maintaining peripherally inserted percutaneous central venous catheters in neonates. J Perinatol. 2010;30(12):794-799. doi:10.1038/jp.2010.46
  21. Birch P, Ogden S, Hewson M. A randomized, controlled trial of heparin in total parenteral nutrition to prevent sepsis associated with neonatal long lines: the Heparin in Long Line Total Parenteral Nutrition (HILLTOP) trial. Arch Dis Child Fetal Neonatal Ed. 2010;95(4):F252-F257. doi:10.1136/adc.2009.167403
  22. Shah PS, Shah VS. Continuous heparin infusion to prevent thrombosis and catheter occlusion in neonates with peripherally placed percutaneous central venous catheters. Cochrane Database Systematic Reviews: CD002772. 2008.
  23. Barekatain, B. etal., Evaluating the effect of high dose versus low dose heparin in peripherally inserted central catheter in very low birth weight infants. Iranian Journal of Pediatrics. 2018;28(3):e60800.

Tools


Copyright © 2025   ºÚÁϳԹÏÍø