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A randomized controlled comparison of flushing protocols in home care patients with peripherally inserted central catheters.
[heparin-induced thrombocytopenia]
Research
has
failed
to
demonstrate
an
optimal
flushing
solution
or
frequency
for
central
catheters
.
In
a
2002
study
of
50
000
home
care
patients
,
catheter
dysfunction
with
loss
of
patency
was
the
most
common
complication
and
occurred
in
29
%
of
the
peripherally
inserted
central
catheters
(
PICCs
)
tracked
.
With
the
advent
of
the
Affordable
Care
Act
and
the
promise
of
expanded
home
care
services
,
this
study
offers
evidence
as
to
a
preferred
flushing
protocol
to
prevent
catheter
patency
complications
for
home
infusion
patients
with
PICCs
.
T
his
prospective
,
randomized
,
1
-
way
,
single
-blinded
posttest
with
control
group
study
was
performed
to
compare
3
commonly
used
flushing
protocols
in
home
infusion
patients
with
PICCs
.
The
independent
variable
was
the
flushing
protocol
,
and
dependent
variables
included
the
development
of
patency-related
complications
and
other
significant
issues
such
as
sluggishness
,
occlusion
,
missed
medication
doses
,
catheter
replacement
,
additional
nursing
visits
,
and
the
use
of
alteplase
(
Cathflo
Activase
)
.
Each
of
the
study
groups
had
patients
who
experienced
1
or
more
patency-related
complications
.
Additional
factors
that
may
affect
catheter
function
,
including
patient
age
,
gender
,
diagnosis
,
therapy
type
,
frequency
of
catheter
use
,
catheter
brand
/
size
/
number
of
lumens
,
concomitant
use
of
anticoagulant
medications
,
and
whether
PICCs
were
used
for
routine
lab
testing
,
were
analyzed
,
and
no
statistical
significance
was
determined
.
Catheter
dwell
time
(
catheter
days
)
was
statistically
significant
(
p
=
.
003
,
confidence
interval
=
95
%
;
assuming
equal
variance
)
and
confirmed
the
assumption
that
the
longer
a
home
care
patient
's
catheter
was
in
place
,
the
more
complications
occurred
.
There
were
no
cases
of
heparin
allergy
,
heparin-induced
thrombocytopenia
,
or
line
infection
.
The
data
provide
some
evidence
to
support
the
elimination
of
heparin
flushing
in
home
care
patients
with
PICCs
,
although
data
in
the
saline-only
group
that
related
to
additional
registered
nurse
visits
to
assess
PICC
patency
and
the
use
of
alteplase
(
Cathflo
Activase
)
were
trending
toward
significance
because
this
group
experienced
a
higher
incidence
of
these
complications
than
both
the
heparin
groups
.
These
findings
should
not
be
translated
to
home
care
patients
with
cancer
or
pregnancy
diagnoses
because
these
populations
were
excluded
from
this
study
.
More
studies
of
this
topic
area
should
be
initiated
.
Please
see
video
abstract
,
Supplemental
Digital
Content
1
,
for
more
information
(
http
:
/
/
links
.
lww
.
com
/
JIN
/
A
3
)
.
Diseases
Validation
Diseases presenting
"loss of patency"
symptom
heparin-induced thrombocytopenia
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