Stephens L C, Haire W D, Tarantolo S, Reed E, Schmit-Pokorny K, Kessinger A, Klein R
Department of Internal Medicine, University of Nebraska Medical Center, Omaha 68198-1210, USA.
Transfus Sci. 1997 Jun;18(2):187-93. doi: 10.1016/s0955-3886(97)00008-8.
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.
血栓形成性闭塞常常是中心静脉导管（CVC）的一种并发症。CVC的最初设计者和生产商推荐使用肝素封管方案来预防血栓形成并保持通畅。尽管没有研究证明肝素封管与导管血栓形成减少之间存在关联，但这已成为标准做法。许多人认为常规使用肝素封管无害。然而，与肝素封管相关的严重并发症，包括药物相互作用以及肝素诱导的血小板减少症和血栓形成综合征（HITS）已被报道。众多比较外周装置中肝素封管与生理盐水封管的研究表明，血栓形成性闭塞的发生率相当。本研究的目的是比较使用肝素封管与生理盐水封管的CVC中血栓形成性闭塞的发生率。该研究纳入了78例接受外周血干细胞采集单采术的癌症患者；其中29例接受生理盐水封管，49例接受肝素（100 U/ml生理盐水）封管。研究终点包括单采术流速缓慢（<50 ml/分钟）、使用尿激酶进行溶栓以及导管血栓形成的影像学证据。两组之间在任何终点方面均未发现显著差异。这些发现表明，生理盐水在保持CVC通畅方面可能与肝素同样有效。
