Department of Nursing, First Affiliated Hospital of Shantou University Medical College, Shantou, People's Republic of China.
Department of Nursing, Third People's Hospital of Chengdu, Chengdu, People's Republic of China.
Int J Nurs Pract. 2021 Apr;27(2):e12913. doi: 10.1111/ijn.12913. Epub 2021 Jan 22.
The use of heparin and 0.9% saline solution is always controversial for central venous catheters. However, there is no systematic review or guideline about whether saline solution can replace heparin solution in adult cancer patients with totally implantable venous access ports (TIVAPs). The purpose of this review is to evaluate whether saline solution can replace heparin saline to lock TIVAPs.
The following databases were searched: PubMed, the Cochrane Library, Web of Science, Embase, CINAHL and Ovid (January 1, 1982, and February 21, 2020). All statistical analyses of the meta-analysis were completed using the Review Manager 5.3.
A total of 201 studies were identified from these databases after initial review, and four studies met inclusion criteria, including 2652 cases. There was little heterogeneity among the included studies (I < 30%), and all analyses were conducted by the fixed-effects model. The total complications, catheter occlusions, catheter-related bloodstream infections and other complication rates in the heparin solution group were higher than in the saline solution group. In the subgroup analysis of heparin concentration, total complication rates in the saline solution group were higher than with 50 U of heparin and lower than with 100 U of heparin. However, the differences in these complications were small, and no significant difference was observed (all P > 0.05).
Based on existing clinical studies, we recommend that saline solution can replace 50 or 100 U/ml of heparin as a safe and effective flush solution for TIVAPs.
肝素和 0.9%生理盐水溶液在中心静脉导管中的应用一直存在争议。然而，目前尚无关于生理盐水溶液是否可以替代肝素溶液用于成人癌症患者完全植入式静脉输液港（TIVAP）的系统评价或指南。本综述的目的是评估生理盐水溶液是否可以替代肝素盐水来封管 TIVAP。
检索了以下数据库：PubMed、Cochrane 图书馆、Web of Science、Embase、CINAHL 和 Ovid（1982 年 1 月 1 日至 2020 年 2 月 21 日）。使用 Review Manager 5.3 完成荟萃分析的所有统计分析。
经过初步审查，从这些数据库中总共确定了 201 项研究，其中 4 项研究符合纳入标准，共包括 2652 例患者。纳入研究的异质性很小（I < 30%），所有分析均采用固定效应模型进行。肝素溶液组的总并发症、导管堵塞、导管相关性血流感染和其他并发症发生率高于生理盐水溶液组。在肝素浓度的亚组分析中，生理盐水溶液组的总并发症发生率高于 50 U 肝素组，低于 100 U 肝素组。然而，这些并发症的差异较小，无显著性差异（均 P > 0.05）。
基于现有临床研究，我们建议生理盐水溶液可以替代 50 或 100 U/ml 的肝素作为 TIVAP 的安全有效的冲洗溶液。
