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Published in: BMC Pediatrics 1/2024

Open Access 01-12-2024 | Heparin | Research

Heparin versus normal saline for the care of peripheral intravenous catheters in pediatrics: a meta-analysis of randomized controlled trials

Authors: Ran Li, Qiaoqi Zheng, Nengyue Chen, Li Zhao

Published in: BMC Pediatrics | Issue 1/2024

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Abstract

Background

It is still controversial for neonates or children to choose normal saline or heparin solution in the care of peripheral intravenous catheters. This meta-analysis aimed to evaluate the effects of heparin versus normal saline for the care of peripheral intravenous catheters in pediatrics, to provide reliable evidence support for clinical care.

Methods

Two authors searched the PubMed, EMbase, Ovid Medline, Cochrane Library, Web of Science, CBM, WanFang Data and China National Knowledge Infrastructure (CNKI) databases for randomized controlled trial (RCT) of heparin versus normal saline for the care of peripheral intravenous catheters in pediatrics until July 16, 2023. The bias of risk tool recommended by Cochrane was used for the quality evaluation of included RCTs. Meta-analysis was carried out by using RevMan 5.4 software.

Results

A total of 22 RCTs involving 3988 peripheral intravenous catheters were finally included. Compare with normal saline, heparin could significantly increase the catheter indwelling time (MD = 9.10, 95%CI:3.30 ~ 14.90). Subgroup analysis indicated that for compare with normal saline, heparin could significantly increase the catheter indwelling time in the neonate (MD = 9.63, 95%CI: 0.38 ~ 18.88) and neonate + children population (MD = 6.22, 95%CI:2.72 ~ 9.73, P < 0.001). Heparin could significantly reduce the incidence of catheter-associated complications (RR = 0.84, 95%CI: 0.70 ~ 0.95). Subgroup analysis indicated that heparin could significantly reduce the incidence of catheter-associated complications in the neonate (RR = 0.70, 95%CI: 0.61 ~ 0.89). There was no publication bias amongst the synthesized outcomes by Egger’s test (all P > 0.05).

Conclusions

Heparin may be worthy of being applicated in the neonate population in terms of prolonged indwelling time and less complications. Limited by the evidence quality, more studies from different area and populations with rigorous design are needed to investigate the role of heparin versus normal saline for the care of peripheral intravenous catheters in pediatrics.
Literature
1.
go back to reference Alberto EC, Mastrianni A, Sullivan TM, McCarthy KH, Milestone ZP, Chung L, Cha N, Mapelli E, Sippel GJ, Marsic I, et al. Factors affecting Peripheral Intravenous Catheter Placement during Pediatric Trauma Resuscitation. J Surg Res. 2023;28(3):241–8.CrossRef Alberto EC, Mastrianni A, Sullivan TM, McCarthy KH, Milestone ZP, Chung L, Cha N, Mapelli E, Sippel GJ, Marsic I, et al. Factors affecting Peripheral Intravenous Catheter Placement during Pediatric Trauma Resuscitation. J Surg Res. 2023;28(3):241–8.CrossRef
2.
go back to reference Simeone S, Gargiulo G, Bosco V, Mercuri C, Botti S, Candido S, Paonessa G, Bruni D, Serra N, Doldo P. Peripheral intravenous catheter insertion and therapy administration: simulator learning. Acta Biomed. 2023;94(3):e2023130.PubMedPubMedCentral Simeone S, Gargiulo G, Bosco V, Mercuri C, Botti S, Candido S, Paonessa G, Bruni D, Serra N, Doldo P. Peripheral intravenous catheter insertion and therapy administration: simulator learning. Acta Biomed. 2023;94(3):e2023130.PubMedPubMedCentral
3.
go back to reference Shimoni Z, Houdhoud N, Isaacs Y, Froom P. Observational study of peripheral intravenous catheter outcomes in an internal medicine department. Intern Med J. 2023;53(2):221–7.PubMedCrossRef Shimoni Z, Houdhoud N, Isaacs Y, Froom P. Observational study of peripheral intravenous catheter outcomes in an internal medicine department. Intern Med J. 2023;53(2):221–7.PubMedCrossRef
4.
go back to reference Indarwati F. Site selection and incidence of peripheral intravenous catheter complications. Evid Based Nurs. 2023;26(3):106–12.PubMedCrossRef Indarwati F. Site selection and incidence of peripheral intravenous catheter complications. Evid Based Nurs. 2023;26(3):106–12.PubMedCrossRef
5.
go back to reference Hontoria-Alcoceba R, López-López C, Hontoria-Alcoceba V, Sánchez-Morgado AI. Implementation of evidence-based practice in Peripheral Intravenous Catheter Care. J Nurs Care Qual. 2023;38(3):226–33.PubMedCrossRef Hontoria-Alcoceba R, López-López C, Hontoria-Alcoceba V, Sánchez-Morgado AI. Implementation of evidence-based practice in Peripheral Intravenous Catheter Care. J Nurs Care Qual. 2023;38(3):226–33.PubMedCrossRef
6.
go back to reference Huang X, Quan X, Pu W. Investigation and analysis of standardized nursing management on the application of clinical peripheral superficial vein indwelling needle. Chin Contemp Nurses. 2022;26(7):4–6. Huang X, Quan X, Pu W. Investigation and analysis of standardized nursing management on the application of clinical peripheral superficial vein indwelling needle. Chin Contemp Nurses. 2022;26(7):4–6.
7.
go back to reference Wang G. Progress in clinical application of peripheral intravenous catheter. Mod Diagnosis Treat. 2023;34(10):1569–72. Wang G. Progress in clinical application of peripheral intravenous catheter. Mod Diagnosis Treat. 2023;34(10):1569–72.
8.
go back to reference Qiu J, Li Y, Zhang K, Jiang Y. Investigation on the use of peripheral venous indwelling needle in newborns. Chinesee Contemp Nurses. 2021;31(15):32–4. Qiu J, Li Y, Zhang K, Jiang Y. Investigation on the use of peripheral venous indwelling needle in newborns. Chinesee Contemp Nurses. 2021;31(15):32–4.
9.
go back to reference Gorski LA, Hadaway L, Hagle ME, Broadhurst D, Clare S, Kleidon T, Meyer BM, Nickel B, Rowley S, Sharpe E, et al. Infusion Therapy standards of Practice, 8th Edition. J Infus Nurs. 2021;44(1):1–224.CrossRef Gorski LA, Hadaway L, Hagle ME, Broadhurst D, Clare S, Kleidon T, Meyer BM, Nickel B, Rowley S, Sharpe E, et al. Infusion Therapy standards of Practice, 8th Edition. J Infus Nurs. 2021;44(1):1–224.CrossRef
10.
go back to reference children Wgoe-bgfcpoiiti. Evidence-based guidelines for clinical practice of intravenous infusion therapy in children. Chin J evidence-based Pediatr. 2021;16(1):1–142. children Wgoe-bgfcpoiiti. Evidence-based guidelines for clinical practice of intravenous infusion therapy in children. Chin J evidence-based Pediatr. 2021;16(1):1–142.
11.
go back to reference Wu X-H, Chen L-C, Liu G-L, Zhang T-T, Chen X-S. Heparin versus 0.9% saline solution to maintain patency of totally implanted venous access ports in cancer patients: a systematic review and meta-analysis. Int J Nurs Pract. 2021;27(2):e12913.PubMedCrossRef Wu X-H, Chen L-C, Liu G-L, Zhang T-T, Chen X-S. Heparin versus 0.9% saline solution to maintain patency of totally implanted venous access ports in cancer patients: a systematic review and meta-analysis. Int J Nurs Pract. 2021;27(2):e12913.PubMedCrossRef
12.
go back to reference Sharma SK, Mudgal SK, Gaur R, Sharma R, Sharma M, Thakur K. Heparin flush vs. normal saline flush to maintain the patency of central venous catheter among adult patients: a systematic review and meta-analysis. J Family Med Prim Care. 2019;30(8):2779–92. Sharma SK, Mudgal SK, Gaur R, Sharma R, Sharma M, Thakur K. Heparin flush vs. normal saline flush to maintain the patency of central venous catheter among adult patients: a systematic review and meta-analysis. J Family Med Prim Care. 2019;30(8):2779–92.
13.
go back to reference Pittiruti M, Boxtel TV, Scoppettuolo G, Carr P, Konstantinou E, Miluy GO, Lamperti M, Goossens GA, Simcock L, Dupont C, et al. European recommendations on the proper indication and use of peripheral venous access devices (the ERPIUP consensus): a WoCoVA project. J Vasc Access. 2023;24(1):165–82.PubMedCrossRef Pittiruti M, Boxtel TV, Scoppettuolo G, Carr P, Konstantinou E, Miluy GO, Lamperti M, Goossens GA, Simcock L, Dupont C, et al. European recommendations on the proper indication and use of peripheral venous access devices (the ERPIUP consensus): a WoCoVA project. J Vasc Access. 2023;24(1):165–82.PubMedCrossRef
14.
go back to reference Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff JM, Akl EA, Brennan SE, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;29(6):372–80. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff JM, Akl EA, Brennan SE, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;29(6):372–80.
15.
go back to reference Higgins JPT, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, Savovic J, Schulz KF, Weeks L, Sterne JAC, et al. The Cochrane collaboration’s tool for assessing risk of bias in randomised trials. BMJ. 2011;343(18):d5928.PubMedPubMedCentralCrossRef Higgins JPT, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, Savovic J, Schulz KF, Weeks L, Sterne JAC, et al. The Cochrane collaboration’s tool for assessing risk of bias in randomised trials. BMJ. 2011;343(18):d5928.PubMedPubMedCentralCrossRef
16.
go back to reference Guyatt GH, Oxman AD, Schunemann HJ, Tugwell P, Knottnerus A. GRADE guidelines: a new series of articles in the Journal of Clinical Epidemiology. J Clin Epidemiol. 2011;64(4):380–2.PubMedCrossRef Guyatt GH, Oxman AD, Schunemann HJ, Tugwell P, Knottnerus A. GRADE guidelines: a new series of articles in the Journal of Clinical Epidemiology. J Clin Epidemiol. 2011;64(4):380–2.PubMedCrossRef
17.
go back to reference Alpan G, Eyal F, Springer C, Glick B, Goder K, Armon J. Heparinization of alimentation solutions administered through peripheral veins in premature infants: a controlled study. Pediatrics. 1984;74(3):375–8.PubMedCrossRef Alpan G, Eyal F, Springer C, Glick B, Goder K, Armon J. Heparinization of alimentation solutions administered through peripheral veins in premature infants: a controlled study. Pediatrics. 1984;74(3):375–8.PubMedCrossRef
18.
19.
go back to reference Heilskov J, Kleiber C, Johnson K, Miller J. A randomized trial of heparin and saline for maintaining intravenous locks in neonates. J Soc Pediatr Nurs. 1998;3(3):111–6.PubMedCrossRef Heilskov J, Kleiber C, Johnson K, Miller J. A randomized trial of heparin and saline for maintaining intravenous locks in neonates. J Soc Pediatr Nurs. 1998;3(3):111–6.PubMedCrossRef
20.
go back to reference Klenner AF, Fusch C, Rakow A, Kadow I, Beyersdorff E, Eichler P, Wander K, Lietz T, Greinacher A. Benefit and risk of heparin for maintaining peripheral venous catheters in neonates: a placebo-controlled trial. J Pediatr. 2003;143(6):741–5.PubMedCrossRef Klenner AF, Fusch C, Rakow A, Kadow I, Beyersdorff E, Eichler P, Wander K, Lietz T, Greinacher A. Benefit and risk of heparin for maintaining peripheral venous catheters in neonates: a placebo-controlled trial. J Pediatr. 2003;143(6):741–5.PubMedCrossRef
21.
go back to reference Upadhyay A, Verma KK, Lal P, Chawla D, Sreenivas V. Heparin for prolonging Peripheral Intravenous Catheter Use in neonates: a randomized controlled trial. J Perinatol. 2015;35(4):274–7.PubMedCrossRef Upadhyay A, Verma KK, Lal P, Chawla D, Sreenivas V. Heparin for prolonging Peripheral Intravenous Catheter Use in neonates: a randomized controlled trial. J Perinatol. 2015;35(4):274–7.PubMedCrossRef
22.
go back to reference White ML, Crawley J, Rennie EA, Lewandowski LA. Examining the effectiveness of 2 solutions used to flush capped pediatric peripheral intravenous catheters. J Infus Nurs. 2011;34(4):260–70.PubMedCrossRef White ML, Crawley J, Rennie EA, Lewandowski LA. Examining the effectiveness of 2 solutions used to flush capped pediatric peripheral intravenous catheters. J Infus Nurs. 2011;34(4):260–70.PubMedCrossRef
23.
go back to reference Tripathi S, Kaushik V, Singh V. Peripheral IVs: factors affecting complications and patency–a randomized controlled trial. J Infus Nurs. 2008;31(3):182–8.PubMedCrossRef Tripathi S, Kaushik V, Singh V. Peripheral IVs: factors affecting complications and patency–a randomized controlled trial. J Infus Nurs. 2008;31(3):182–8.PubMedCrossRef
24.
go back to reference Treas LS, Latinis-Bridges B. Efficacy of heparin in peripheral venous infusion in neonates. J Obstet Gynecol Neonatal Nurs. 1992;21(3):214–9.PubMedCrossRef Treas LS, Latinis-Bridges B. Efficacy of heparin in peripheral venous infusion in neonates. J Obstet Gynecol Neonatal Nurs. 1992;21(3):214–9.PubMedCrossRef
25.
go back to reference Sun Y. Comparison of the effect of two kinds of sealing solution in neonatal peripheral venous catheterization. China Maternal and Child Health Research. 2016;36(2):2–4. Sun Y. Comparison of the effect of two kinds of sealing solution in neonatal peripheral venous catheterization. China Maternal and Child Health Research. 2016;36(2):2–4.
26.
go back to reference Schultz AA, Drew D, Hewitt H. Comparison of normal saline and heparinized saline for patency of IV locks in neonates. Appl Nurs Res. 2002;15(1):28–34.PubMedCrossRef Schultz AA, Drew D, Hewitt H. Comparison of normal saline and heparinized saline for patency of IV locks in neonates. Appl Nurs Res. 2002;15(1):28–34.PubMedCrossRef
27.
go back to reference Paisley MK, Stamper M, Brown J, Brown N, Ganong LH. The use of heparin and normal saline flushes in neonatal intravenous catheters. Pediatr Nurs. 1997;23(5):521–7.PubMed Paisley MK, Stamper M, Brown J, Brown N, Ganong LH. The use of heparin and normal saline flushes in neonatal intravenous catheters. Pediatr Nurs. 1997;23(5):521–7.PubMed
28.
go back to reference Nelson TJ, Graves SM. 0.9% sodium chloride injection with and without heparin for maintaining peripheral indwelling intermittent-infusion devices in infants. Am J Health Syst Pharm. 1998;55(6):570–3.PubMedCrossRef Nelson TJ, Graves SM. 0.9% sodium chloride injection with and without heparin for maintaining peripheral indwelling intermittent-infusion devices in infants. Am J Health Syst Pharm. 1998;55(6):570–3.PubMedCrossRef
29.
go back to reference Mudge B, Forcier D, Slattery MJ. Patency of 24-gauge peripheral intermittent infusion devices: a comparison of heparin and saline flush solutions. Pediatr Nurs. 1998;24(2):142–9.PubMed Mudge B, Forcier D, Slattery MJ. Patency of 24-gauge peripheral intermittent infusion devices: a comparison of heparin and saline flush solutions. Pediatr Nurs. 1998;24(2):142–9.PubMed
30.
go back to reference Mok E, Kwong TKY, Chan MF. A randomized controlled trial for maintaining peripheral intravenous lock in children. Int J Nurs Pract. 2007;13(1):33–45.PubMedCrossRef Mok E, Kwong TKY, Chan MF. A randomized controlled trial for maintaining peripheral intravenous lock in children. Int J Nurs Pract. 2007;13(1):33–45.PubMedCrossRef
31.
go back to reference Moclair A, Bates I. The efficacy of heparin in maintaining peripheral infusions in neonates. Eur J Pediatr. 1995;154(7):567–70.PubMedCrossRef Moclair A, Bates I. The efficacy of heparin in maintaining peripheral infusions in neonates. Eur J Pediatr. 1995;154(7):567–70.PubMedCrossRef
32.
go back to reference McMullen A, Fioravanti ID, Pollack V, Rideout K, Sciera M. Heparinized saline or normal saline as a flush solution in intermittent intravenous lines in infants and children. MCN Am J Matern Child Nurs. 1993;18(2):78–85.PubMedCrossRef McMullen A, Fioravanti ID, Pollack V, Rideout K, Sciera M. Heparinized saline or normal saline as a flush solution in intermittent intravenous lines in infants and children. MCN Am J Matern Child Nurs. 1993;18(2):78–85.PubMedCrossRef
33.
go back to reference Kotter RW. Heparin vs saline for intermittent intravenous device maintenance in neonates. Neonatal Netw. 1996;15(6):43–7.PubMed Kotter RW. Heparin vs saline for intermittent intravenous device maintenance in neonates. Neonatal Netw. 1996;15(6):43–7.PubMed
34.
go back to reference Kleiber C, Hanrahan K, Fagan CL, Et A. Heparin Vs. saline for peripheral I. V. Locks in children. Pediatr Nurs. 1993;19(4):405–9.PubMed Kleiber C, Hanrahan K, Fagan CL, Et A. Heparin Vs. saline for peripheral I. V. Locks in children. Pediatr Nurs. 1993;19(4):405–9.PubMed
35.
go back to reference John S, Vetriselvi. Comparison of efficacy of normal saline with heparinised saline flushing on patency of Peripheral Intravenous Catheters-A Randomized double blind clinical trial. Int J Curr Res. 2015;7(11):23286–90. John S, Vetriselvi. Comparison of efficacy of normal saline with heparinised saline flushing on patency of Peripheral Intravenous Catheters-A Randomized double blind clinical trial. Int J Curr Res. 2015;7(11):23286–90.
36.
go back to reference Goldberg M, Givelichian L, Sankaran K. Maintaining patency of peripheral infusion Devices with saline and heparinized saline. A Randomized Control Trial. Pediatr Res. 1999;11(3):6–14. Goldberg M, Givelichian L, Sankaran K. Maintaining patency of peripheral infusion Devices with saline and heparinized saline. A Randomized Control Trial. Pediatr Res. 1999;11(3):6–14.
37.
go back to reference Beecroft P, Bossert E, Chung K. Intravenous lock patency in children: dilute heparin versus saline. Pediatrics. 1997;15(3):10–7. Beecroft P, Bossert E, Chung K. Intravenous lock patency in children: dilute heparin versus saline. Pediatrics. 1997;15(3):10–7.
38.
go back to reference Arnts IJJ, Heijnen JA, Wilbers HTM, Wilt G-J, Groenewoud JMM, Liem KD. Effectiveness of heparin solution versus normal saline in maintaining patency of intravenous locks in neonates: a double blind randomized controlled study. J Adv Nurs. 2011;67(12):2677–85.PubMedCrossRef Arnts IJJ, Heijnen JA, Wilbers HTM, Wilt G-J, Groenewoud JMM, Liem KD. Effectiveness of heparin solution versus normal saline in maintaining patency of intravenous locks in neonates: a double blind randomized controlled study. J Adv Nurs. 2011;67(12):2677–85.PubMedCrossRef
40.
go back to reference Kumar M, Vandermeer B, Bassler D, Mansoor N. Low-dose heparin use and the patency of peripheral IV catheters in children: a systematic review. Pediatrics. 2013;131(3):864–72.CrossRef Kumar M, Vandermeer B, Bassler D, Mansoor N. Low-dose heparin use and the patency of peripheral IV catheters in children: a systematic review. Pediatrics. 2013;131(3):864–72.CrossRef
41.
go back to reference Shah PS, Ng E, Sinha AK. Heparin for prolonging peripheral intravenous catheter use in neonates. Cochrane Database Syst Rev. 2005;19(4):CD002774. Shah PS, Ng E, Sinha AK. Heparin for prolonging peripheral intravenous catheter use in neonates. Cochrane Database Syst Rev. 2005;19(4):CD002774.
42.
go back to reference You T, Jiang J, Chen J, Xu W, Xiang L, Jiao Y. Necessity of heparin for maintaining peripheral venous catheters: a systematic review and meta-analysis. Exp Ther Med. 2017;14(2):1675–84.PubMedPubMedCentralCrossRef You T, Jiang J, Chen J, Xu W, Xiang L, Jiao Y. Necessity of heparin for maintaining peripheral venous catheters: a systematic review and meta-analysis. Exp Ther Med. 2017;14(2):1675–84.PubMedPubMedCentralCrossRef
43.
go back to reference López-Briz E, Garcia VR, Cabello JB, Bort-Marti S, Sanchis RC, Burls A. Heparin versus 0.9% sodium chloride intermittent flushing for prevention of occlusion in central venous catheters in adults. Cochrane Database Syst Rev. 2014;8(10):CD008462. López-Briz E, Garcia VR, Cabello JB, Bort-Marti S, Sanchis RC, Burls A. Heparin versus 0.9% sodium chloride intermittent flushing for prevention of occlusion in central venous catheters in adults. Cochrane Database Syst Rev. 2014;8(10):CD008462.
44.
go back to reference López-Briz E, Garcia VR, Cabello JB, Bort-Martí S, Sanchis RC. Heparin versus 0.9% sodium chloride locking for prevention of occlusion in central venous catheters in adults. Cochrane Database Syst Rev. 2022;7(7):CD008462.PubMed López-Briz E, Garcia VR, Cabello JB, Bort-Martí S, Sanchis RC. Heparin versus 0.9% sodium chloride locking for prevention of occlusion in central venous catheters in adults. Cochrane Database Syst Rev. 2022;7(7):CD008462.PubMed
45.
go back to reference Wen Z, Shen M, Wang Z. Meta analysis of the effect of PICC irrigating with normal saline and heparin sodium. J Nurs. 2017;24(1):6–9. Wen Z, Shen M, Wang Z. Meta analysis of the effect of PICC irrigating with normal saline and heparin sodium. J Nurs. 2017;24(1):6–9.
46.
go back to reference Xie G, Huang X, Zou J. A comparative study on the effect of preflushing catheter irrigator and heparin sodium saline on intravenous BD indwelling needle sealing. Jilin Med. 2019;40(2):3–6. Xie G, Huang X, Zou J. A comparative study on the effect of preflushing catheter irrigator and heparin sodium saline on intravenous BD indwelling needle sealing. Jilin Med. 2019;40(2):3–6.
47.
go back to reference Li S, Di Y. Meta analysis of sealing effects of different concentrations of heparin sodium and normal saline with peripheral venous indwelling needle in patients with ischemic stroke. Chin Maternal Child Health Res. 2017;40(16):2–6. Li S, Di Y. Meta analysis of sealing effects of different concentrations of heparin sodium and normal saline with peripheral venous indwelling needle in patients with ischemic stroke. Chin Maternal Child Health Res. 2017;40(16):2–6.
48.
go back to reference Wang W, Wang Y, Kang Q. Systematic evaluation and Meta analysis of heparin or normal saline prolonging the indwelling time of short peripheral venous catheters. Chin J evidence-based Pediatr. 2022;17(1):28–34. Wang W, Wang Y, Kang Q. Systematic evaluation and Meta analysis of heparin or normal saline prolonging the indwelling time of short peripheral venous catheters. Chin J evidence-based Pediatr. 2022;17(1):28–34.
Metadata
Title
Heparin versus normal saline for the care of peripheral intravenous catheters in pediatrics: a meta-analysis of randomized controlled trials
Authors
Ran Li
Qiaoqi Zheng
Nengyue Chen
Li Zhao
Publication date
01-12-2024
Publisher
BioMed Central
Published in
BMC Pediatrics / Issue 1/2024
Electronic ISSN: 1471-2431
DOI
https://doi.org/10.1186/s12887-023-04515-y

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