Veterans Administration Surgical Services, William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin, USA.
JPEN J Parenter Enteral Nutr. 2010 Jul-Aug;34(4):444-9. doi: 10.1177/0148607110362082.
A common problem that complicates use of central venous access devices (CVADs) is occlusion by thrombosis. Alteplase, a recombinant tissue plasminogen activator, is used to restore line patency when thrombosis occurs. Heparin flush is commonly used to prevent this complication, but the effectiveness of this practice is unclear. A recent heparin shortage allowed examination of heparin effectiveness in reducing CVAD thrombosis.
A retrospective cohort study was performed by querying a pharmacy database for alteplase use for CVAD thrombosis in adult patients during periods when heparin flushes (10 units/mL) were used and when saline flushes were used instead because of a nationwide heparin shortage. The number of patients receiving alteplase, the number of doses administered, and the total amount of alteplase used were compared over 1-month intervals of heparin flush use and 1-month intervals of saline flush use. Patient days and critical care patient days were compared between these time intervals. Peripherally inserted central catheter (PICC) line placements and replacements between time periods of heparin and saline flush were also compared.
Significant increases in the number of patients receiving alteplase (P = .04), the number of alteplase doses administered (P = .04), and total dose of alteplase used (P = .05) occurred during the heparin shortage. No significant differences in patient population were observed. The percentage of PICC line replacements also increased significantly (P < .05) when heparin was not available.
Heparin flush (10 units/mL) decreases thrombotic occlusions of CVADs, resulting in decreased alteplase use and fewer PICC line replacements.
中央静脉通路装置(CVAD)阻塞是一个常见的问题,血栓形成是造成这种阻塞的一个主要原因。阿替普酶(一种重组组织型纤溶酶原激活物)可用于恢复血管通畅,当血栓形成时。肝素冲洗通常用于预防这种并发症,但这种做法的效果尚不清楚。最近肝素短缺,允许检查肝素在减少 CVAD 血栓形成方面的有效性。
通过查询药房数据库,对成人患者在使用肝素冲洗(10 单位/毫升)和因全国肝素短缺而改用生理盐水冲洗期间,使用阿替普酶治疗 CVAD 血栓形成的情况进行回顾性队列研究。在肝素冲洗使用 1 个月和生理盐水冲洗使用 1 个月的间隔期间,比较接受阿替普酶治疗的患者数量、给予的剂量和使用的阿替普酶总量。比较这些时间间隔之间的患者天数和重症监护患者天数。还比较了肝素和生理盐水冲洗时间段之间的外周插入中心导管(PICC)置管和更换情况。
在肝素短缺期间,接受阿替普酶治疗的患者数量(P =.04)、给予的阿替普酶剂量(P =.04)和使用的阿替普酶总量(P =.05)均显著增加。未观察到患者人群有显著差异。当肝素不可用时,PICC 导管更换的比例也显著增加(P <.05)。
肝素冲洗(10 单位/毫升)可减少 CVAD 的血栓性阻塞,从而减少阿替普酶的使用和减少 PICC 导管更换。