MAINTAINING CENTRAL

LINE PATENCY USING

NORMAL SALINE VERSUS
HEPARIN
Kimberly Lin
Azusa Pacific University
GNRS 507: Scientific Writing
Diana Rodriguez, Ph.D., MSN, CNS, RN
August 3, 2017
Key terms
Central Line aka central
venous catheter
PICC lines
Tunneled Catheter
Totally implanted venous
access devices (TIVADs)
Port-a-Caths aka
Ports

Withdrawal Occlusion
Introduction & Background
Heparin traditionally used to prevent lock TIVADs
Still a 33% occlusion rate
Heparin-induced thrombocytopoenia
Platelet destruction/bleeding (Garajov et al., 2013;
Milani et al., 2017)
Current Hospital Policies Scripps Green &
UCSD Jacobs Medical Center
PICOT Question
In oncology patients with TIVADs, does 0.9% NS,
compared to heparin use, also prevent line occlusion
when used to lock TIVADs between treatments?
Key Points
Goossens et al. (2013) randomized control trial results
showed withdrawal occlusion in:
0.9% NS group:109 (3.5%) of 3,109 catheter
assessments
Heparin group: 115 (3.8%) of 3,017 catheter
assessments
Bertoglio et al. (2012) cohort studies showed rate of
irreversible catheter occlusion:
0.9% NS group: 5.7% participants
Heparin group: 6.7%
Hierarchy of Evidence
Methods: CINAHL and EBSCOhost databases:
keywords normal saline, heparin, central lines,
TIVADs, and occlusion.
Hierarchy of Evidence: (5) Cohort studies Level IV, (2)
randomized control trials Level II, and (1) meta-analysis
Level I (Stillwell et al. (2010))

RCT: Goossens et al. (2013)

Meta-analysis: Zhong et al. (2017)
Cohort Study: Bertoglio et al. (2012)
Clinical Implications
Outpatient oncology
Flushing & locking procedures
Only 0.9% NS
Before & After blood sampling
After every IV medication infusion
Every 8 weeks when port is not in use
20 mL to flush port immediately after blood
tranfusion
20 mL to flush port immediately after parenteral
nutrition
Lock with 0.9% NS
Barriers & Facilitators
Barriers Facilitators
Cost of staff Risk of heparin-
education & training related
0.9% NS also complications
imperfect
Alteplase
Expected Outcomes & Measurements
Outcome measurement: Frequency of withdrawal
occlusion defined as easy injection, impossible
aspiration (Goossens et al., 2010)
Patients treated on outpatient basis
Compare 6 months of strict 0.9% NS use to retrospective
6 month heparin use
Ethical Considerations
American Code of Ethics for Nurses (2008):
Provision 3 states that the nurse promotes, advocates for,
and strives to protect the health, safety, and rights of the
patient.

Ethical principle of:

Beneficence
Conclusions
Research exists that supports the use of 0.9% NS in
preventing line occlusion

Nurses as change agents with inherent duty to promote

best practice

Further research more homogeneity in study design,

malignancy type, port placement and type, geography
References
Research exists that supports the use of 0.9% NS in
preventing line occlusion

Nurses as change agents with inherent duty to promote

best practice

Further research more homogeneity in study design,

malignancy type, port placement and type, geography