PURPOSE: Catheter occlusion (inability to infuse or withdraw fluids) has been reported to occur in up to 25% of central venous catheters. Controversy exists regarding the type of flush solution which best prevents catheter occlusion, however, there is little data to support the use of heparin versus normal saline for these flushes. We attempted to identify the incidence of catheter and port occlusion with the use of saline, as opposed to heparin, flushes in our ICU.
METHODS: We collected data on 500 triple lumen central venous catheter line days (1500 port days). Other types of lines were excluded from the study.Our standard line flush protocol is to flush each unused port of the central with 10cc of normal saline every 8 hours. Occlusion was evaluated as a function of gender, line position(subclavian, femoral or internal jugular), number of ports infusing and line day. Patients on full anticoagulation were excluded, but those on standard DVT prophylaxis were included. Once a line malfunctioned it was excluded from further data collection. The line was removed at the discretion of the clinician.
RESULTS: We found the incidence of line and port occlusion to be 4.8% and 2.9% respectively, significantly less than previously reported. There was no statistical difference in the incidence of line occlusion based on age, gender or line position, however we did find a statistically significant difference between the number of ports being infused and the incidence of line malfunction. We found a very low incidence of occlusion in lines less than 4 days old, with a peak occlusion rate on day 7.
CONCLUSION: Use of normal saline only flushes is effective in preventing line occlusion and also prevents unnecessary exposure to heparin and its adverse effects, especially heparin induced thrombocytopenia (HIT). Further study is needed to determine the etiology of the occlusion in those lines affected.
CLINICAL IMPLICATIONS: Saline flushing appears to be effective in preventing line occlusion in triple lumen catheters, especially in those lines less than 4 days old.
DISCLOSURE: Leo Rotello, None.