A Comparison of the Effectiveness of Using Heparinised Saline versus 0.9% Sodium Chloride to Prevent Central Venous Catheter Occlusion in People with a Totally Implantable Venous Access Device (TIVAD’s): A Systematic Review

Abstract

Historically in the UK, unfractionated heparin (heparinised saline), has been used to reduce the occlusion rate of central venous catheters (CVCs) used for renal dialysis. This practice was carried across to other CVC’s, including totally implantable venous access devices (TIVAD’s). However, heparin use carries risks such as infection, thrombocytopenia, bleeding and interactions with other drugs. The aim of this systematic review was to determine the effectiveness of heparinised saline versus 0.9% sodium chloride to prevent TIVAD occlusion in people with cystic fibrosis (CF). We included 6 databases and 4 trial registry platforms. Due to a lack of studies within the CF population, participants of included studies were people with a TIVAD and applicability to the CF population was reviewed. The primary outcome measure was catheter occlusion rate. Eight studies were included, four RCTs, three retrospective non-randomised trials and one observational study. Statistical pooling and subgroup analysis was not possible. All eight of the studies concluded there was no statistically significant difference in occlusion rates and that heparin was not superior to 0.9% sodium chloride. Secondary outcomes showed no statistical difference in line infection rates or complications. There was one incident of heparin induced thrombocytopenia. Our review found no reliable evidence that 0.9% sodium chloride is inferior to heparinised saline in the maintenance of TIVAD patency. In view of the risks associated, 0.9% sodium chloride offers a potentially safer, equally effective, cost saving alternative.